1. To provide comprehensive information on unmet needs for service and barriers to accessing services.
2. To examine effects of different systems of organizing and delivering care on outcomes such as cost, utilization, survival, patient satisfaction, and quality of life.
3. To examine effects of patient characteristics (including gender, race/ethnicity, substance abuse, mental health, socioeconomic status, insurance coverage) on outcomes such as service utilization, unmet service needs, and costs.
4. To provide data on service utilization and costs for a representative sample of rural residents with HIV infection.
5. To examine patterns of transition between different types of provider (e.g., private physician to public clinic) and the relationship of such transitions to changes in clinical status, employment, and insurance coverage.

This study will be the first to obtain a true national random sample of people with HIV infection receiving treatment. Approximately 3200 adult patients in urban and rural areas will be enrolled. Study will be co-sponsored by HRSA, NIMH, NIDR, NIA, NIDA, and the Robert Wood Johnson Foundation.

HIV Costs and Service Utilization Study (HCSUS).

HIV-infected individuals receiving treatment.

A Community Advisory Board, comprising members of infected and affected groups, has been established.

To examine health care utilization among participants in the NIH-sponsored Women's Interagency HIV Study (WIHS).

1. Supplement the WIHS by adding a health services research component.
2. Collect and analyze utilization data on women with HIV infection (in addition to the detailed clinical data obtained in the core study.)

Women's Interagency HIV Study (WIHS).

Women with HIV infection participating in the WIHS.

A broad representation of researchers and patient advocates had input in the development of the WIHS.

To examine factors affecting health care utilization among participants in the NIH-sponored Multicenter AIDS Cohort Study (MACS).

1. Supplement the MACS by adding a health services research component.
2. Collect and analyze utilization data on men with HIV infection (in addition to the detailed clinical data obtained in the core study).

Multicenter AIDS Cohort Study (MACS).

Homosexual and bisexual men participating in the MACS in four urban areas.

A broad representation of researchers and patient advocates had input in the development of the MACS.

To examine health care utilization among participants in the CDC-sponsored HIV Epidemiological Research Study (HERS).

1. Supplement the HERS by adding a health services research component.
2. Collect and analyze utilization data on women with HIV infection (in addition to the detailed clinical data obtained in the core study).

HIV Epidemiological Research Study (HERS).

Women with HIV infection participating in the HERS.

A broad representation of researchers and patient advocates had input in the development of the HERS.

1. To provide longitudinal data on utilization of inpatient, outpatient, home care, pharmaceutical, and other services, and to estimate their associated costs.
2. To examine the impact of a Medicaid Home and Community-Based waiver on service utilization, costs, functional status, and survival.
3. To examine any substitutions of formal for informal home care.

1. Conduct interviews with participants in New Jersey Medicaid Waiver program.
2. Abstract data from Medicaid claims.

Health Care Costs and Utilization in AIDS Home Care.

Medicaid recipients with AIDS in New Jersey.

Persons with AIDS residing at home or in community facilities.

To examine types of ambulatory care providers used to treat HIV infection, patterns of transitions between ambulatory provider types, and service utilization and costs for pediatric HIV patients.

Analyze Medicaid claims and eligibility data from New York State Medicaid files.

Ambulatory Care for HIV/AIDS, Models and Outcomes.

* Part of overall operating budget

New York State Medicaid recipients.

NA

To assess the impact of antiretroviral, antimicrobial, and prophylactic treatment on the natural history of HIV infection, and the effect of pharmaceutical therapies on service utilization, costs, and clinical outcomes.

Develop clinical database linked to Medicaid claims data.

Outcomes of Pharmaceutical Therapy in HIV Disease.

HIV-infected population in Maryland.

NA

To study issues of costs and quality of care, with a focus on women and children, examine trends and variation in adherence to scientifically-based clinical guidelines, and study predictors of variation in treatment, by patient, physician, and practice setting characteristics.

Analyze Medicaid claims and eligibility data, supplemented with AIDS Registry data.

Quality and Costs of Care for HIV Infected Medicaid Patients.

* Part of overall operating budget

New Jersey Medicaid recipients.

NA

To develop an econometric framework for the simultaneous study of health care usage and survival, and synthetic estimates of per-person lifetime costs of HIV disease for various groups of HIV-infected individuals.

Formulate statistical models and associated computer software.

Developing Econometric Models to Estimate AIDS Costs.

Participants in the AIDS Costs and Service Utilization Survey, with potential extensions to all persons with HIV disease.

NA

To identify personal and institutional factors that shape physicians' willingness to care for HIV-infected patients.

Conduct the third in a series of interviews with physicians, who are currently in their sixth post-graduate year.

Determinants of Physicians' AIDS-Related Practice Behavior.

Persons with AIDS.

Physicians

Continuing work previously completed with AHCPR support, compare outcomes of inpatient care for AIDS provided by dedicated AIDS units versus scattered-bed approaches.

Expand upon original comparative multi-site observational study of 20 hospitals.

Outcomes of Hospital Dedicated AIDS Units.

1300 patients receiving services in study hospitals.

NA

Obtain and analyze data on inpatient hospital utilization by people with HIV infection.

Assemble and analyze database of hospital discharge data from all hospitals in 12 States.

Hospital Cost and Utilization Project.

Patients with AIDS receiving inpatient care in hospitals in 12 states.

NA

1. To examine access to primary medical care for HIV positive African Americans who are linked to health services through community-based case management.
2. To improve access to primary medical care for HIV positive African Americans.
3. To create a model of assessment of primary health care access that could be utilized in other urban African-American communities.

In-depth structured interviews, unstructured interviews, focus groups, participant observation and direct observation.

Study entitled "Access to Primary Health Care for HIV+ African Americans".

African-American and Euro-American clients in the greater Tampa metropolitan area.

New clients at three ethnically diverse community-based case management sites.

1. To develop better conceptual and operational delineation of "health care related trust".
2. To describe the factors that potentiate or mitigate trust among HIV positive and HIV negative inmates.
3. To determine the effect of trust on health seeking behavior and adherence to medical therapy among HIV positive inmates.

In-depth interviews, focus group discussions, and administration of standardized surveys to inmates.

Study entitled "Trust and HIV-Related Health Behavior Among Connecticut Inmates".

Prisoners in Connecticut.

HIV positive inmates in treatment, HIV positive inmates not in treatment, and HIV negative inmates.

To gain an understanding of the health values and the determinants of health values of HIV positive patients.

Conduct focus groups, pose standard gamble, time tradeoff, and rating scale questions, and conduct intensive individual interviews.

Study entitled "Understanding Health Values of HIV-infected Patients"

HIV-positive patients

Patients will be recruited from a university-based AIDS treatment center which serves nearly all HIV positive patients in the study area.