Does Access to Health Care Impact Survival Time after Diagnosis of AIDS?

Lack of access to health care is often blamed for poor health outcomes, but this effect is not supported by existing HIV/AIDS literature. The authors examined the association between access to care and survival time after progression to AIDS, using survival analysis methods. This study combined data from two CDC sponsored studies of HIV-infected persons, a cross-sectional interview study and a longitudinal medical record review study. Study subjects included 752 persons who progressed to AIDS before December 31, 1999, and were patients at either of two major HIV care facilities in Detroit, MIchigan. Separate statistical models were used to test associations between survival time after meeting the criteria for AIDS and two indicators of access to health care: (1) perceived access to health care and (2) health care utilization patterns. Perceived access was not associated with survival time after AIDS, but patterns of health care utilization were significantly associated with survival time after AIDS (HR = 2.04, p < 0.001). Individuals who received a greater proportion of their care in the ER had a worse survival prognosis than those who received more of their health care in an outpatient clinic setting. It is crucial that we provide HIV-infected populations with tools that enable them to access a regular source of health care.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/63272/1/10872910252972276.pd

Improving the Representativeness of Behavioral and Clinical Surveillance for Persons with HIV in the United States: The Rationale for Developing a Population-Based Approach

The need for a new surveillance approach to understand the clinical outcomes and behaviors of people in care for HIV evolved from the new challenges for monitoring clinical outcomes in the HAART era, the impact of the epidemic on an increasing number of areas in the US, and the need for representative data to describe the epidemic and related resource utilization and needs. The Institute of Medicine recommended that the Centers for Disease Control and Prevention and the Heath Resources and Services Administration coordinate efforts to survey a random sample of HIV-infected persons in care, in order to more accurately measure the need for prevention and care services. The Medical Monitoring Project (MMP) was created to meet these needs. This manuscript describes the evolution and design of MMP, a new nationally representative clinical outcomes and behavioral surveillance system, and describes how MMP data will be used locally and nationally to identify care and treatment utilization needs, and to plan for prevention interventions and services

Scheduling unrelated parallel machines with optional machines and jobs selection

[EN] In this paper we study two generalizations of the well known unrelated parallel machines scheduling problem under makespan (Cmax) minimization. First, a situation in which not every available parallel machine should be used and it is desirable to employ only a subset of the parallel machines. This is referred to as Not All Machines or NAM in short. This environment applies frequently in production shops where capacity exceeds demand or when production capacity can be lent to third companies. Also, NAM can be used to increase production capacity and it is not clear how many additional machines should be acquired. The second studied generalization has been referred to as Not All Jobs or NAJ. Here, there is no obligation to process all available jobs. We propose Mixed Integer Programming mathematical formulations for both NAM and NAJ, and it is shown that the latter can be effectively solved with modern commercial solvers. We also present three algorithms to solve the NAM problem. These algorithms are compared with the proposed MIP formulation when solved with IBM ILOG CPLEX 12.1. Comprehensive computational and statistical experiments prove that our proposed algorithms significantly improve the results given by the solver. © 2011 Elsevier Ltd. All rights reserved.The authors would like to thank the anonymous referees for their careful and detailed comments which have helped to improve this manuscript considerably. This work is partially funded by the Spanish Ministry of Science and Innovation, under the project ‘‘SMPA—Advanced Parallel Multiobjective Sequencing: Practical and Theoretical Advances’’ with reference DPI2008-03511/DPI. The authors should also thank the IMPIVA—Institute for the Small and Medium Valencian Enterprise, under the project ‘‘OSC’’ with references IMIDIC/2008/137, IMIDIC/2009/198 and IMIDIC/2010/175 and the Polytechnic University of Valencia, under the project ‘‘PPAR— Production Programming in Highly Constrained Environments: New Algorithms and Computational Advances’’ with reference 3147.Fanjul Peyró, L.; Ruiz García, R. (2012). Scheduling unrelated parallel machines with optional machines and jobs selection. Computers and Operations Research. 39(7):1745-1753. https://doi.org/10.1016/j.cor.2011.10.012S1745175339

Quality of Care for HIV Infection Provided by Ryan White Program-Supported versus Non-Ryan White Program-Supported Facilities

BACKGROUND: The Ryan White HIV/AIDS Care Act (now the Treatment Modernization Act; Ryan White Program, or RWP) is a source of federal public funding for HIV care in the United States. The Health Services and Resources Administration requires that facilities or providers who receive RWP funds ensure that HIV health services are accessible and delivered according to established HIV-related treatment guidelines. We used data from population-based samples of persons in care for HIV infection in three states to compare the quality of HIV care in facilities supported by the RWP, with facilities not supported by the RWP. METHODOLOGY/PRINCIPAL FINDINGS: Within each area (King County in Washington State; southern Louisiana; and Michigan), a probability sample of patients receiving care for HIV infection in 1998 was drawn. Based on medical records abstraction, information was collected on prescription of antiretroviral therapy according to treatment recommendations, prescription of prophylactic therapy, and provision of recommended vaccinations and screening tests. We calculated population-level estimates of the extent to which HIV care was provided according to then-current treatment guidelines in RWP-supported and non-RWP-supported facilities. For all treatment outcomes analyzed, the compliance with care guidelines was at least as good for patients who received care at RWP-supported (vs non-RWP supported) facilities. For some outcomes in some states, delivery of recommended care was significantly more common for patients receiving care in RWP-supported facilities: for example, in Louisiana, patients receiving care in RWP-supported facilities were more likely to receive indicated prophylaxis for Pneumocystis jirovecii pneumonia and Mycobacterium avium complex, and in all three states, women receiving care in RWP-supported facilities were more likely to have received an annual Pap smear. CONCLUSIONS/SIGNIFICANCE: The quality of HIV care provided in 1998 to patients in RWP-supported facilities was of equivalent or better quality than in non-RWP supported facilities; however, there were significant opportunities for improvement in all facility types. Data from population-based clinical outcomes surveillance data can be used as part of a broader strategy to evaluate the quality of publicly-supported HIV care