Adapting RARE to assess barriers to service receipt among people out of care.

This paper describes the components of Rapid Assessment, Response and Evaluation (RARE), developed for HIV prevention planning; the adaptation of its methods to services planning; the venues in which the use of RARE was recommended for the present Care System Assessment Demonstration Project; constraints on what projects using RARE and the system assessment model may expect to accomplish; the focus of RARE questions for the project, concerning the characteristics of PLWH not in regular primary care, the care system as PLWH not in care perceive and experience it, and characteristics of the physical and social environments in which they live; how information from RARE can contribute to the enhancement of care systems; and the types of questions that sites could ask to gather RARE information for services planning.

The care system assessment model and its operationalization.

The care system assessment model is intended to help community planning bodies for HIV services conduct systematic evaluations of existing care systems, with an eye toward changing them to make services more accessible to people living with HIV (PLWH) from underserved minority communities. The model has four structural and three cultural/behavioral dimensions. The structural dimensions are system comprehensiveness, capacity, integration, and accessibility; the cultural/behavioral dimensions are service acceptability, technical competencies (of both providers and potential system users), and client health-seeking behaviors.

Background--the origins of the care system assessment demonstration project.

The Care System Assessment Demonstration Project was designed to assist community planning bodies in determining barriers to care for people living with HIV (PLWH) in selected underserved minority populations and generating recommendations for care system enhancement that would lower those barriers. This paper describes the selection of three sites to participate in the project and sketches the two primary tools used in implementing the project: Rapid Assessment, Response and Evaluation (RARE) techniques initially developed to assess community HIV prevention needs, and a system assessment model created to help communities conduct systematic evaluations of their HIV care systems. The paper also provides an overview of the remaining chapters of the supplement, detailing how the project was implemented at the national level and the three participating sites and evaluating both the project's process and its local impact.

Making the connection: the importance of engagement and retention in HIV medical care.

Despite the availability and proven efficacy of medical treatment, many individuals living with HIV in the United States today are not engaged in regular HIV medical care or receiving antiretroviral medications. This journal supplement highlights results of a national 5-year multisite Outreach Initiative, funded by the Health Resources and Services Administration (HRSA) in 2001 to "engage people in HIV care, turn sporadic users of care into regular users, and promote retention in care." The introductory paper for the supplement provides background information on the characteristics of individuals who are not engaged in regular HIV care, the barriers they face, intervention options, and the public policy implications of this issue.

Utilization of health care services in hard-to-reach marginalized HIV-infected individuals.

To benefit from HIV treatment advances individuals must utilize ambulatory primary care services. Few studies focus on marginalized populations, which tend to have poor health care utilization patterns. This study examined factors associated with health care utilization in hard-to-reach marginalized HIV-infected individuals.

Ryan White CARE Act service use by Asian/Pacific Islanders and other clients in three California metropolitan areas (1997-1998).

The HIV epidemic disproportionately affects historically underserved members of racial/ethnic minorities. This paper compares HIV service use patterns for 653 Asians and Pacific Islanders (APIs) with those of other racial and ethnic minority clients (N = 28,201) at three selected Ryan White Comprehensive AIDS Resource Emergency (CARE) Act grantee sites in California. Study results show a relatively high proportion of APIs with advanced HIV disease.