Association between ancillary services and clinical and behavioral outcomes among HIV-infected women

The purpose of this study was to evaluate the association between ancillary services, including case management, and clinical and behavioral outcomes for human immunodeficiency virus (HIV)-infected women. Data were obtained f rom databases systematically maintained by Family Advocacy, Care and Educat ion Services (FACES) and the HIV Outpatient Program (HOP) in New Orleans. H IV-infected women receiving primary care from HOP and ancillary services fr om FACES between January 1, 1997 and December 31, 1998 were eligible. Data were analyzed using generalized estimating equations (GEE) with STATA softw are. The majority of women included in the study were African American (86. 7%), infected heterosexually (78.8%), and had absolute CD4 counts greater t han 200 (58.6%). After adjusting for age, time, entry time into HOP, pregna ncy, CD4 count, substance abuse status, and social and clinical stressors, receipt of more than four combined case manager contacts or ancillary servi ces per month was significantly associated with being prescribed a protease inhibitor, improved adherence and retention in primary care, and enrolling on a research protocol. Receiving more than one transportation service per month was significantly associated with improved adherence, improved reten tion, one or more emergency room visits per month, and one or more hospital izations per month. Receiving more than one contact with case managers per month was associated with improved retention in primary care. Findings sugg est that receipt of case management and ancillary services is associated wi th improvements in multiple outcomes for HIV-infected women. A client-cente red approach to providing ancillary services appears to be effective in imp roving behavioral and utilization characteristics in this population of low -income, high-risk women.