Prevalence and predictors of unmet need for supportive services among HIV-infected persons: impact of case management

Med Care. 2000 Jan;38(1):58-69. doi: 10.1097/00005650-200001000-00007.


Background: Previous research has indicated that the needs of persons infected with human immunodeficiency virus (HIV) for supportive services often go unmet. Although case management has been advocated as a method of decreasing unmet needs for supportive services, its effectiveness is poorly understood.

Objectives: To assess the prevalence of need and unmet need for supportive services and the impact of case managers on unmet need among HIV-infected persons.

Research design: National probability sample.

Participants: A total of 2,832 HIV-infected adults receiving care.

Measures: Need and unmet need for benefits advocacy, housing, home health, emotional counseling, and substance abuse treatment services.

Results: Sixty-seven percent of the sample had a need for at least one supportive service, and 26.6% had an unmet need for at least one service in the previous 6 months. Contingent unmet need (unmet need among persons who needed the service) was greatest for benefits advocacy (34.6%) and substance abuse treatment (27.6%). Fifty-seven percent of the sample had had contact with their case manager in the previous 6 months. In multiple logistic regression analysis, with adjustment for covariates, having a case manager was associated with decreased unmet need for home healthcare (OR =0.39; 95% CI = 0.25-0.60), emotional counseling (OR = 0.54; 95% CI = 0.38-0.78), and any unmet need (OR = 0.70; 95% CI = 0.54-0.91). An increased number of contacts with a case manager was significantly associated with lower unmet need for home health care, emotional counseling, and any unmet need.

Conclusions: Need and unmet need for supportive services among HIV-infected persons is high. Case management programs appear to lower unmet need for supportive services.

Publication types

  • Research Support, Non-U.S. Gov't
  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Adult
  • Case Management / organization & administration*
  • Counseling
  • Female
  • HIV Infections / complications
  • HIV Infections / therapy*
  • Health Services Needs and Demand / statistics & numerical data*
  • Health Services Research
  • Home Care Services
  • Humans
  • Insurance Benefits
  • Logistic Models
  • Male
  • Multivariate Analysis
  • Needs Assessment / classification*
  • Patient Advocacy
  • Program Evaluation
  • Social Support*
  • Substance-Related Disorders / complications
  • Substance-Related Disorders / therapy
  • United States