Date of Award

12-2009

Document Type

Dissertation

Degree Name

Doctor of Philosophy (PhD)

Program

Health Sciences Administration

Research Advisor

Dick R. Gourley

Committee

Craig Dorko Theora A. Evans Junling Wang Shelley White-Means

Keywords

Children of HIV-infected parents, health outcomes, healthcare utilization, HIV-affected children

Abstract

With the advent of effective antiretroviral medication and increased expectancy of life span among HIV-infected individuals has lead to an increase in the at-risk population of uninfected children living with their HIV-infected parent(s). The purpose of this study was to investigate the impact of parent’s HIV status on their child’s access to healthcare resources, healthcare utilization and health outcomes.

This was a cross-sectional study in which the information on the children of HIV seropositive parent(s) was collected through a face-to-face interview of the HIV-infected parents having children currently residing with them. The comparative group comprising of children of HIV seronegative parents was obtained from the Medical Expenditure Panel Survey (MEPS) 2006 database. HIV seronegative children aged between 2 yrs and 15 yrs of HIV seropositive as well as HIV seronegative parent(s) were included in this study. A parent was identified as HIV seropositive if they had a prior diagnosis of HIV/AIDS (ICD-9-CM 042, 043, V08) by a physician and had at least one record of a HIV positive serological test result in the past 6 months in their medical records. A parent was defined HIV seronegative if there were no diagnosis of HIV/AIDS (ICD-9-CM 042, 043, V08) in their medical records in MEPS 2006 database. Each child of HIV seropositive parent (primary group) was matched with two children of HIV seronegative parents (comparative group) using the Mahalanobis Distance Metric matching including the propensity score technique. Bivariate and two step multivariable logistic and negative binomial regression analysis was conducted to assess the relationship between the parent’s HIV status and potential variables of interest.

Upon matching, 89 children of HIV seropositive parent(s) matched with 178 children of HIV seronegative parents (1:2 ratio), thus making the final study sample of 267 participants. No differences were observed between the groups in terms of their mean age (8.47 vs 8.94 yrs, p=0.6265), parent’s age (33.57 vs 34.21 yrs, p=0.9464) and other socio-economic and parent’s health insurance variables. This study found no difference between the children in terms of their access to health insurance (97.75% vs 96.63%, p=0.7227) and access to regular source of medical care (87.64% vs 86.68%, p=0.4453). However, a larger number of children of HIV seropositive parent(s) had prescription insurance (95.51% vs 16.29%, p=<0.0001) compared to children of HIV seronegative parents. Also, children of HIV seropositive parent(s) took more time and expressed having difficulty in getting to a healthcare provider compared to children of HIV seronegative parents. Children of HIV seropositive parent(s) were 1.682 times (95% CI: 1.115-6.453) more likely to have a physician visit and had 49% (p=0.0206) more visits to a doctor than the children of HIV seronegative parents. No differences were observed in the likelihood of the children in having a hospital visit or an emergency room visit. However, among children who had a hospital visit and among those who had an emergency room visit, children living with their HIV seropositive parent had 3.0 times more hospital visits (p=0.0244) and 86% more emergency room visits (p=0.0464) compared to children living with HIV seronegative parents, respectively. No relationship was noted between the parent’s HIV status and the child’s absenteeism in school/daycare due to illness (OR: 0.938, 95% CI: 0.425-2.069). However, children of HIV seropositive parent were 4.041 times more likely (95% CI: 1.887-13.471) to be overweight. Though no difference in the likelihood of these children being currently on prescription medication was observed (OR: 0.918, 95% CI: 0.413-2.042), among those who were currently on any medication, children of HIV seropositive parent(s) were more likely to be on a medication for a mental health problem (OR: 5.520, 95% CI: 1.503-20.276).

This study concluded that HIV status of the parent has significant impact on the child’s access in getting to a healthcare provider. It was also found that children of HIVinfected parent(s) had higher utilization of physician’s visits. Higher incidences of obesity and consumption of psychotropic medications among children of HIV seropositive parent(s) signify serious impact of the parent’s HIV status on the nutrition and psychological growth of the child. Further studies are recommended to investigatethe exact cause and long term impacts of the findings observed in this study.

DOI

10.21007/etd.cghs.2009.0104

Comments

One year embargo expired December 2010

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