Background: The Ryan White Care Act funds HIV care for most HIV infected persons in the United States. There is little data on the efficacy of care given by this program. The Parkland Health and Hospital System (PHHS) HIV Department treats over 3500 HIV infected patients who receive primary care, lab tests (CD4 count and HIV-1 plasma RNA (VL)) and anti-retroviral therapy (ART) funded by Ryan White titles I, II, III, and IV.
Methods: The Parkland HIV Database was queried for patients treated from1998-1999. This observational database contains demographic, pharmacy, clinic visit data, CD4 counts and VL. Patients were classified by use of Ryan White services; low (< 5 clinic visits/2 yrs), normal (5-14 clinic visits/2yrs), and high use (>14 visits/2 yrs). Monthly proportional of patients with the following outcomes was determined: ART; PCP prophylaxis; and VL < 400 copies/ml. Effect of use on outcome was determined by Cox Proportional Hazards model adjusting for CD4 counts and VL.
Results: Compared low users, PCP prophylaxis was more likely in normal (OR = 1.8, P < 0.001) and high users (OR = 2.4, P < 0.001). Similarly, ART was more likely in the normal (OR = 3.3, P < 0.001) and high users (OR= 5.2, P < 0.001). Compare to low users, VL < 400 copies/ml was more likely in normal (OR= 1.3, P =0.001) but not in high users (P= 0.12). This was due to lower CD4 counts in the high users. Women were less likely to be receive ART (OR = 0.75, P < 0.001), and PCP prophylaxis (OR = 0.75, P=0.001), but were more likely to have and VL < 400 copies/ml than men (OR = 1.2, P < 0.001).
Conclusion. Patients who regularly use a Ryan White funded clinic are more likely to receive PCP prophylaxis, ART and to have and HIV-1 plasma RNA < 400 copies ml. Women were treated less but were more likely than men to achieve an VL< 400 copies ml. This data suggests that the Ryan White program is effective in providing care to HIV-1 infected patients.








The XIV International AIDS Conference
Abstract no. MoPeB3151