The 130th Annual Meeting of APHA

Abstract #45941

Susan Abramowitz, PhD, Pediatrics, New York University School of Medicine, NB 8-West 40 11, 550 First Avenue, New York, NY 10016, 212/2638797, susan.abramowitz@med.nyu.edu, Philip Alcabes, PhD, Program in Urban Public Health, Hunter College, 425 East 25th Street, New York, NY 10010, Elizabeth Frank, PhD, Pediatrics, NYU School of Medicine, 550 First Avenue, Room NB-8W-50, New York, NY 10016, and Keith Krasinski, MD, Pediatrics and Environmental Medicine, New York University School of Medicine, NB 8-West 51, 550 First Avenue, New York, NY 10016.

Ryan White CARE Act (RWCA) funding impact on clinical outcomes of 650 infected and uninfected children followed between 1985 and 1999 in an urban pediatric infectious diseases clinic was assessed. Study data included computer databases supplemented by chart abstraction.  Independent variables - RWCA funding phases (pre funding (I), implementation (II), institutionalization (III)); demographics; treatments (PCP, MAI, MAC prophylaxis; HAART; maternal zidovudine); clinic and hospital visits.  Clinical outcomes- disease progression, survival, hospitalizations, opportunistic infections, perinatal infection, and developmental functioning. Laboratory outcomes - CD4% and viral load. Within and between phase comparisons were undertaken.  Hierarchical regression procedures in the Poisson or logistic framework were used to analyze temporal effects, including group-level associations of RWCA program implementation with clinical care and outcomes. RWCA funding resulted in: 1) delivery of service to a minority population of women and children; 2) improved care access measured by enrollment in prenatal care and for children, age at first visit; and 3) Phase related (I, II, III) declines in: rate of development of mild symptoms (1.3%/yr, 0.9%/yr to 0); progression from asymptomatic to AIDS: (19.5%/yr, 10.2%/yr, 3.1%/yr); proportion aged > 30 days at 1st visit (13.7%, 8.7%, 0); CD4% loss: (0.23, 0.08, 0.07); mortality rate (person years): (18, 6.4, 2); and increase in prenatal antiretroviral therapy: (1.3%, 27.4%, 93.7%). Cognitive scores declined from ages 13 forward, despite improved clinical outcomes. Cognitive delay, common in children from urban settings, is likely further exacerbated by the socioemotional and physical strain of parental HIV-infection.

Learning Objectives:

• - Recognize the importance of Ryan White CARE Act funding to the delivery of HIV/AIDS services for children and families;
• - Describe the divergence between the clinical and developmental outcomes and hypothesize as to their antecedents; and,
• - Identify the limitations in the methodological approach.

Keywords: HIV/AIDS, Outcomes Research

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Presenting author's disclosure statement:
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.