ACCESS TO MEDICAL-CARE AND HEALTH-RELATED QUALITY-OF-LIFE FOR LOW-INCOME PERSONS WITH SYMPTOMATIC HUMAN-IMMUNODEFICIENCY-VIRUS

Despite growing interest in the accessibility of medical care and heal th-related quality of life for persons infected with human immunodefic iency virus, an association between these variables has not been docum ented. The authors conducted a cross-sectional study of access to care and its association with health-related quality of life among 205 per sons of low income infected with the human immunodeficiency virus with constitutional symptoms and/or diarrhea at one public and one Veteran s Administration hospital, using a 9-item measure of perceived access and a 55-item health-related quality of life instrument. Problems with access were widespread: 55% traveled for longer than 30 minutes to th eir usual source of care (compared with 9% to 12% of general populatio ns in national surveys), 49% had problems meeting costs of care, and 4 8% had problems with clinic hours (compared with 23% in national surve ys). In multivariate analyses, uninsured patients reported worse acces s than patients with Medicaid or Veterans Administration insurance, pa rticularly for meeting the cost of care (P < 0.01). Adjusted health-re lated quality of life scores in this sample were far lower (by about 1 SD) than those of subjects in a large national acquired immune defici ency syndrome clinical trial. For 8 of 11 health-related quality of li fe subscales, worse perceived access was significantly (P < 0.05) asso ciated with poorer health-related quality of life, even after controll ing for T-4 lymphocyte count, symptoms and other factors. Access and h ealth-related quality of life measures similar to those used in this s tudy may prove useful in future evaluations of medical care systems se rving poor, clinically ill populations infected with human immunodefic iency virus.