Journal of acquired immune deficiency syndromes and human retrovirology : official publication of the International Retrovirology Association
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J. Acquir. Immune Defic. Syndr. Hum. Retrovirol. · Jan 1997
ReviewScience, politics, and AIDS prevention policy.
The relationships among science, politics, and health care policy have changed dramatically over the years since AIDS was first diagnosed in the United States. Initially politics was viewed as inimical to prevention; now it is viewed as central. ⋯ More recently, the political climate has been more sympathetic, but whether this will result in a more effective health-care policy is not yet clear. Two important debates continue in AIDS prevention policy: (a) the issue of whether prevention efforts should be targeted to high-risk populations and geographic areas or should be more broadly focused, and (b) whether prevention priorities are best established through democratic participation that includes federal government agencies, local health departments, and community-based organizations.
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J. Acquir. Immune Defic. Syndr. Hum. Retrovirol. · Aug 1996
Multicenter StudyPredictors of resource utilization for hospitalized patients with Pneumocystis carinii pneumonia (PCP): a summary of effects from the multi-city study of quality of PCP care.
To determine whether patient and hospital characteristics were significantly associated with variations in Pneumocystis carinii (PCP) care and outcomes, we analyzed the use of diagnostic tests, intensive care units (ICUs), anti-PCP medications for persons hospitalized with human immunodeficiency virus (HIV)-related PCP, and hospital discharge status. We conducted retrospective chart reviews of a cohort of 2,174 patients with PCP hospitalized in 1987-1990. ⋯ After we adjusted for differences in this severity of illness, we noted that Medicaid patients, injection drug users (IDUs), and patients treated at VA or county hospitals were significantly less likely than others to have diagnostic bronchoscopies and that persons covered by Medicaid, with a previous diagnosis of acquired immunodeficiency syndrome (AIDS), who did not receive prior zidovudine (AZT) or who received care in a VA hospital had the highest chances of in-hospital death. Insurance and risk group characteristics, severity of illness, and hospital characteristics appear to be the most important determinants of the intensity and timing of medical care and outcomes among patients hospitalized with PCP.
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J. Acquir. Immune Defic. Syndr. Hum. Retrovirol. · May 1996
Off-label drug use in human immunodeficiency virus disease.
We wished to determine the extent to which drugs used to treat HIV disease and its clinical manifestations are prescribed for conditions other than those listed on the U. S. Food and Drug Administration's approved drug label, how such "off-label" use varies by patient characteristics and type of HIV-related medical condition, and the extent to which physicians alter the way they treat HIV-related conditions because of reimbursement problems associated with off-label drug use. ⋯ The use of drugs for off-label indications in HIV care is common and frequently represents community standards of care. Reliance on drug compendia for support of off-label drug use accounts for the majority of such uses, although many legitimate off-label uses may not be included because of compendia publication lag. The prevalence of off-label drug use in routine clinical practice and the development of newer and more costly drugs for treatment of HIV and its medical complications argues for the articulation of an explicit national reimbursement policy for off-label uses of prescription drugs so that medically appropriate therapies will be available to those with insurance in a rational, consistent way.
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J. Acquir. Immune Defic. Syndr. Hum. Retrovirol. · May 1996
Comparative Study Clinical Trial Controlled Clinical TrialImpact of missing data due to dropouts on estimates of the treatment effect in a randomized trial of antiretroviral therapy for HIV-infected individuals. Canadian HIV Trials Network A002 Study Group.
To evaluate the impact of missing data due to nonrandom dropout on estimates of the effect of treatment on the CD4 count in a clinical trial of antiretroviral therapy for HIV infected individuals. ⋯ Missing outcome data due to dropouts can result in an underestimation of the treatment effect and overly optimistic statements about the outcome of participants on both treatment arms due to the selective dropout of participants with lower or decreasing CD4 counts. When there are significant dropout rates in randomized trials, imputation is a useful technique to assess the range of plausible values of the treatment effect.
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J. Acquir. Immune Defic. Syndr. Hum. Retrovirol. · Apr 1996
Cesarean deliveries and maternal-infant HIV transmission: results from a prospective study in South Africa.
Data from a prospective study undertaken at an urban hospital in Durban, South Africa, were used to investigate associations between maternal-infant HIV transmission, mode of delivery, and specific circumstances of cesarean deliveries. A total of 141 children of HIV-infected women were followed until the children were 15 months of age to determine their HIV status. supplementary data were collected from obstetric records, masked to the HIV status of the children. ⋯ Singleton cesarean deliveries without concurrent obstetric complications had lower rates of transmission than did vaginal deliveries (OR, 0.20; 95% CI, 0.04-0.94). These results suggest that certain intrapartum events may modify the risk of HIV transmission and highlight the importance of collecting more detailed intrapartum information in order to clarify the route by which mode of delivery may be associated with maternal-infant HIV transmission.