Question 1: What are the patterns of utilization of HIV services of persons in Louisiana?
This section focuses on information that pertains to HRSA HIV/AIDS
care planning groups. Specifically, this section characterizes the
patterns in the use of services by a number of populations in the state
of Louisiana. The information was provided by HRSA-funded programs as
well as supplemental studies that have been conducted to examine
specific aspects of HIV care in Louisiana.
In 1990, Congress enacted the Ryan White CARE Act to provide funding
for states, territories, and EMAs to offer primary care and support
services for persons living with HIV disease who lack health insurance
and financial resources for their care. Congress reauthorized the Ryan
White CARE Act in 1996 and in 2000 to support Titles I–IV, Special
Projects of National Significance (SPNS), the HIV/AIDS Education
Training Centers and the Dental Reimbursement Program, all of which are
part of the CARE Act.
Highlights
- Ryan White CARE Act Title II clientele reflected the population in
Louisiana affected by the epidemic in 2001. Sex, race/ethnicity, and age of
the CARE Act clientele were similar to those of persons reported to the
Louisiana Office of Public Health HIV/AIDS Surveillance System.
- During 2001, Ryan White CARE Act Title II funds were used primarily to
provide case management and medical care services to the 4,125 clients
enrolled in the program.
- Through the Louisiana AIDS Drug Assistance Program (ADAP), 1,440
persons received antiretroviral therapy (ART) in June 2001. Most of these
persons were male, black, 19 years of age or older, and at or below 200% of
the poverty level.
- Results from the Survey of HIV Disease and Care illustrate the
widespread prescribing of ART (86%) and highly active antiretroviral therapy
(HAART) (64%) in 1998 among HIV patients in southeastern Louisiana.
Prophylaxis for Pneumocystis carinii pneumonia (PCP) was prescribed less
frequently (indicated on the medical charts of only 58% of eligible
patients). Few differences were noted in the prescribing of ART, HAART, or
PCP prophylaxis, with the exception of insurance status.
- The 2000 Adult/Adolescent Spectrum of HIV Disease (ASD) study reported
that HAART was prescribed to 76% of patients and that the practice did not
differ substantially by patient characteristics. Overall, PCP prophylaxis
was prescribed for 76% of eligible patients, and prophylaxis for
Mycobacterium avium complex (MAC) was prescribed for a similar proportion
(70%). These medications were prescribed for larger proportions of black
patients than for white or Hispanic patients.
- Analysis of HIV testing delays shows that some groups may not have had
access to, or may not have used, available counseling and testing services
early in the course of infection.
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The purpose of Title II funding is to improve the quality,
availability, and organization of health care and support services for
individuals and families with, or affected by, HIV disease in each state
or territory. In addition, the funding provides access to needed
pharmaceuticals through ADAP.
In 2001, a total of 4,125 clients received services funded through
the Ryan White Title II award; of these, 871 persons were new clients.
During 2001, the distribution of Title II CARE Act clients by
race/ethnicity, sex, and age was similar to the distribution of these
characteristics among persons known to be living with HIV/AIDS in
Louisiana at the end of 2001 (Table 27).
Most of the visits of the 4,125 Louisiana Title II clients who
received services during 2001 involved case management (n = 2,231),
followed by medical care (n = 770).
Louisiana is unique in that it provides annual funding to 10 regional
public medical centers to provide care to uninsured, low-income, or
indigent patients, including those
living with HIV/AIDS. Therefore, CARE Act funds are used only to
supplement primary medical care in areas where gaps in services have
been identified (New Orleans, Baton Rouge, and Monroe). Few clients
received substance abuse or mental health services (Table 28). In 2001,
the average number of visits by Title II clients was highest for case
management services (9 visits/client). Title II clients who sought
dental care made an average of 3 visits related to dental care during
2001.
In addition to the services listed in
Table 28, CARE Act funds were
used to provide the following services to clients during 2001: food bank
or home-delivered meals (n = 1,682 clients), emergency financial
assistance (n = 1,389), transportation (n = 1,194), client advocacy (n =
816), home health care (n = 160), companion or buddy services (n = 134)
and a variety of other support services (n = 1,131).
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