Utilization and Insurance Among HIV Positive Drug Users. Executive Summary

摘要

This study examined health service utilization among a population of 1,881 injecting drug users with known HIV serostatus. In addition to characterizing the types of health service use and factors associated with utilization, the study also included a two-year prospective analysis of predictors of zidovudine use as well as correlates of early versus late initiation of zidovudine. Finally, the study examined correlates of change in insurance coverage over a two-year period. In our cross sectional analysis of health service utilization, we found that the strongest predictor of utilization of both inpatient and outpatient health care services was the presence of two or more HIV related symptoms. The presence of health insurance was found to be marginally associated with inpatient admissions. In our prospective analysis of correlates of zidovudine use, we found that only 42% of individuals who met the Centers for Disease Control criteria for use of zidovudine reported taking this medication. This finding suggests that injection drug users are not entering the health care system until late in the course of their HIV disease. In our analysis of changes in health insurance coverage over time, we found that in spite of initial and continuous high levels of health insurance coverage among the majority of injecting drug users, HIV positive serostatus and symptoms still differentiated those with more months of health insurance. The lack of a routine health care provider, as well as barriers associated with the lack of health insurance, and the consequences of heavy injection drug use, all contribute to the unmet health care needs of this population.