Survival patterns among HIV+ individuals based on health care utilization.

The purpose of this study was to determine if HIV+ persons who first obtained health care in New Orleans through public hospital inpatient services had a higher risk of death or disease progression than patients who first entered care through public outpatient services. The sites included the largest HIV outpatient clinic in the Gulf South, two early intervention sites and a public hospital. A medical record review on patients who attended these sites from July 1995 through December 1999 and were enrolled in the Adult Spectrum of Disease (ASD) Study was conducted (n = 3402). The multivariate analysis examined the associations between inpatient services and the main effects. Kaplan-Meier analysis and Cox proportional hazards regression were performed. Risk of death or disease progression was analyzed for three different endpoints: time from study entry to death, time from HIV to AIDS, and time from AIDS to death. The multivariate analysis showed that patients first entering care through inpatient services were significantly more likely to be African American, have AIDS, and use drugs. The risk of death or disease progression was significantly higher for all three endpoints. Results from this study indicate that HIV+ individuals receiving initial care through public hospital inpatient services may require more effective early intervention.