Important note: Information in this article was accurate in 2003. The state of the art may have changed since the publication date.
Trends in Pediatric Care and Outcomes
AIDS & Public Policy Journal 18, no. 1/2 (Spring/Summer 2003) 35-45 Susan Abramowitz, Philip Alcabes, and Keith Krasinski
We investigated changes in access, quality of care, and clinical outcomes in 624 HIV-infected and HIV-affected infants and children seen in the pediatric infectious diseases clinic of a large urban hospital between 1985 and 1999. The independent variables, which included demographics, treatment, and utilization of services, were obtained from routine clinical databases and supplemented with chart abstraction when necessary. Time was included as an independent variable, as a proxy for federal, state, and private investment in research and service delivery and the resulting contributions to advances in care. Time was categorized into three phases: Phase I represented the onset of the epidemic, when investment in research and care was modest and knowledge about treatment was developing (1985-1991); Phase II represented the midpoint of the epidemic in the U.S. (1992-1996), marked by the disbursement of large sums of Ryan White CARE Act and NIH research dollars; Phase III, more recently, was marked by the widespread implementation of HAART in pediatric patients (1997-1999). Analysis of temporal effects and outcomes by phase was performed using Poisson or logistic regression procedures. Over time, access to care-as measured by enrollment in prenatal care for pregnant women and age at first visit for children-improved. Phase-related declines were observed in rate of development of mild symptoms, progression from asymptomatic to AIDS, proportion aged >30 days at first visit, CD4 percent loss, mortality rate, and increase in prenatal antiretroviral therapy. The outcomes of pediatric care have steadily improved since the epidemic's onset, coincident with, and likely the result of, increased governmental support leading to clinical advances and the expansion of, and coordination of, care.
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Important note: Information in this article was accurate in 2003. The state of the art may have changed since the publication date.
