CLINIC HIV-FOCUSED FEATURES AND PREVENTION OF PNEUMOCYSTIS-CARINII PNEUMONIA

OBJECTIVE: To examine the association of clinic HIV-focused features a nd advanced HIV care experience with Pneumocystis carinii pneumonia (P CP) prophylaxis and development of PCP as the initial AIDS diagnosis. DESIGN: Nonconcurrent prospective study, SETTING:New York State Medica id Program, PARTICIPANTS: Medicaid enrollees diagnosed with AIDS in 19 90-1992, MEASUREMENTS AND MAIN RESULTS: We collected patient clinical and health care data from Medicaid files, conducted telephone intervie ws of directors of 125 clinics serving as the usual source of care for study patients, and measured AIDS experience as the cumulative number of AIDS patients treated by the study clinics since 1986. Pneumocysti s carinii pneumonia prophylaxis in the 6 months before AIDS diagnosis and PCP at AIDS diagnosis were the main outcome measures, Bivariate an d multivariate analyses adjusted for clustering of patients within cli nics. Of 1,876 HIV-infected persons, 44% had PCP prophylaxis and 38% h ad primary PCP. Persons on prophylaxis had 20% lower adjusted odds of developing PCP (95% confidence interval [CI] 0.64, 0.99), The adjusted odds of receiving prophylaxis rose monotonically with the number of H IV-focused features offered by the clinic, with threefold higher odds (95% CI 1.6, 5.7) for six versus two or fewer such features, Patients in clinics with three HIV-focused features had 36% lower adjusted odds of PCP than those in clinics with one or none, Neither clinic experie nce nor specialty had a significant association with prophylaxis or PC P. CONCLUSIONS: PCP prevention in our study cohort appears to be more successful in clinics offering an array of HIV-focused features.