Assessing quality of primary care provided to the HIV-infected Ryan White population in the Baltimore Eligible Metropolitan Area

Abstract

The Baltimore Eligible Metropolitan Area (EMA) receives Ryan White (RW) funds each year because of its high AIDS case rate. This study assessed the quality of primary care services provided to HIV-infected clients in the Baltimore EMA. Medical charts of 384 randomly selected clients served in 2004 were reviewed. A survey instrument was designed to assess the minimum requirements satisfied for CD4 and viral load count, highly active antiretroviral treatment, pneumocystitis carinii pneumonia and mycobacterium avium complex prophylaxis, tuberculosis, syphilis, hepatitis B and C screening and safe sex education. A numeric index of quality was developed for each client in the form of a total score. The clients were categorized into high, medium and low quality groups depending on their total scores. Only 32% of clients were in the high-quality category. Number of primary care visits per year (P <or= .0001) was found to be significantly associated with quality of care. Proactive efforts are needed at the provider level to keep or reengage HIV clients in care.