Richard M. Rutstein, MD, Kelly A. Gebo, MD, MPH, George K. Siberry, MD, MPH, Patricia M. Flynn, MD, Stephen A. Spector, MD, Victoria L. Sharp, MD, and John A. Fleishman, PhD

Med Care 2005;43: III-31–III-39

Background
The aging of the pediatric HIV cohort and advances in antiretroviral therapy for children may have resulted in recent changes in patterns of healthcare utilization.

Objectives
The objectives of this study were to examine inpatient and outpatient HIV-related health service utilization in a multistate sample of HIV-infected children, and to assess sociodemographic and clinical correlates of utilization.

Design
Cohort study of pediatric patients with HIV. Demographic, clinical, and resource utilization data were collected from medical records for 2000 and 2001. Setting: This study was conducted at 4 U.S. HIV primary pediatric and specialty care sites in different geographic regions.

Patients
Three hundred three HIV-positive children with at least one outpatient visit or CD4 test in either 2000 or 2001 were studied. Main Outcome Measures: Mean outcome measures were number of hospital admissions, mean length of hospital stay, and number of outpatient clinic/office visits.

Results
Hospitalization rates decreased significantly from 39.2 (95% confidence interval _CI_, 28.4 –50.1) to 25.3 (95% CI, 16.4– 34.3) admissions per 100 patients between 2000 and 2001. Hospitalizations were higher among patients with greater immunosuppression, those 2 years and under, and those with AIDS, but were not significantly related to receipt of highly active antiretroviral therapy. Mean outpatient visits did not change significantly between 2000 and 2001 from 9.09 (95% CI, 8.3–9.9) to 9.06 (95% CI, 8.4 –9.7) visits per child per year. Children 2 years and under, those on highly active antiretroviral therapy, those with AIDS, and those with Medicaid had significantly higher outpatient utilization. Those with higher HIV-1 RNA had higher outpatient utilization than those with less advanced disease.

Conclusion
Inpatient utilization significantly decreased between 2000 and 2001, but outpatient utilization did not change over time. Compared with prior studies, utilization rates appear to be declining over time. Unlike adults, racial/ethnic or gender disparities in healthcare utilization are less pronounced for HIV-infected children.

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