| Optimizing resource allocation in United States AIDS drug assistance programs. | |
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MedLine Citation:
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PMID: 17051505 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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BACKGROUND: US acquired immunodeficiency syndrome (AIDS) Drug Assistance programs (ADAPs) provide medications to low-income patients with human immunodeficiency virus (HIV) infection/AIDS. Nationally, ADAPs are in a fiscal crisis. Many states have instituted waiting lists, often serving clients on a first-come, first-served basis. We hypothesized that CD4 cell count-based ADAP eligibility would improve ADAP outcomes, allowing them to serve more-diverse patient populations and to prioritize persons who are at greatest risk of HIV-related mortality. METHODS: We used Massachusetts ADAP administrative data to create a retrospective cohort of Massachusetts ADAP clients from fiscal year 2003. We then used a model-based analysis to apply potential eligibility criteria for a limited program and to compare characteristics of patients included under CD4 cell count-based and first-come, first-served eligibility criteria. RESULTS: In fiscal year 2003, Massachusetts ADAPs served 3560 clients at a direct cost of 10.3 million dollars. With use of CD4 cell count-based eligibility (with an eligibility criterion of a current or nadir CD4 cell count < or = 350 cells/microL), it would have served 2253 clients (37% fewer than in fiscal year 2003) and appreciated savings of 2.7 million dollars. Given the same budget constraint and using first-come, first-served eligibility, Massachusetts ADAPs would have served 2406 clients (32% fewer than in fiscal year 2003). The first-come, first-served approach would have excluded patients with median CD4 cell count of 257 cells/microL (interquartile range, 124-377 cells/microL) in favor of serving patients with median CD4 cell count of 659 cells/microL (interquartile range, 511-841 cells/microL). In addition, a CD4 cell count-based scheme would have served a greater proportion of nonwhite individuals (65% vs. 55%; P<.0001), non-English speakers (24% vs. 19%; P=.03), and unemployed people (69% vs. 61%; P=.0009), compared with the population that would have been served by a first-come, first-served policy. CONCLUSIONS: With limited resources, ADAPs will serve more-diverse populations and patients with significantly more advanced HIV disease by using CD4 cell count-based enrollment criteria rather than a first-come, first-served approach. |
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Authors:
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Benjamin P Linas; Hui Zheng; Elena Losina; Annette Rockwell; Rochelle P Walensky; Kevin Cranston; Kenneth A Freedberg |
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Publication Detail:
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Type: Journal Article; Research Support, N.I.H., Extramural; Research Support, Non-U.S. Gov't Date: 2006-10-17 |
Journal Detail:
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Title: Clinical infectious diseases : an official publication of the Infectious Diseases Society of America Volume: 43 ISSN: 1537-6591 ISO Abbreviation: Clin. Infect. Dis. Publication Date: 2006 Nov |
Date Detail:
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Created Date: 2006-10-19 Completed Date: 2006-11-27 Revised Date: 2007-12-03 |
Medline Journal Info:
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Nlm Unique ID: 9203213 Medline TA: Clin Infect Dis Country: United States |
Other Details:
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Languages: eng Pagination: 1357-64 Citation Subset: IM |
Affiliation:
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Division of General Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA 02114, USA. blinas@partners.org |
Export Citation:
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APA/MLA Format Download EndNote Download BibTex |
| MeSH Terms | |
Descriptor/Qualifier:
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Anti-HIV Agents*
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therapeutic use CD4 Lymphocyte Count Government Programs HIV Infections / drug therapy*, immunology HIV Protease Inhibitors / therapeutic use Humans Poverty* Resource Allocation* United States |
| Grant Support | |
ID/Acronym/Agency:
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K23 AI01794/AI/NIAID NIH HHS; K24 AI062476/AI/NIAID NIH HHS; K25 AI50436/AI/NIAID NIH HHS; P30 AI060354/AI/NIAID NIH HHS; R01 AI42006/AI/NIAID NIH HHS; T32 HP11001-18//PHS HHS |
| Chemical | |
Reg. No./Substance:
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0/Anti-HIV Agents; 0/HIV Protease Inhibitors |
| Comments/Corrections | |
Comment In:
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Clin Infect Dis. 2006 Nov 15;43(10):1365-7
[PMID:
17051506
]
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From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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