Quality of HIV care within the Veterans Affairs health system: A comparison using outcomes from the HIV cost and services utilization study

• Objectives: To assess the quality of care HIV-infected veterans receive through the Veterans Affairs (VA) health care system. • Design: Cross-sectional analysis of 2 cohort studies using medical record review. • Setting and participants: 3840 HIV-infected veterans receiving medical care in 2001 and 2002 at 16 VA facilities and 1874 participants in the HIV Cost and Services Utilization Study (HCSUS). • Main outcome measures: Quality indicators were measured as the percentage of eligible persons receiving highly active antiretroviral therapy (HAART); prophylaxis for Pneumocystis carinii pneumonia (PCP) and Mycobacterium avium complex (MAC); and screening for syphilis, toxoplasmosis, hepatitis A, B, and C infection, and dyslipidemia. • Results: 78% of eligible veterans received HAART, 65% received prophylaxis for PCP, and 99% received prophylaxis for MAC. Eligible veterans were screened for toxoplasmosis (44%), syphilis (74%), hepatitis A (55%), B (67%), and C (75%), and dyslipidemia (67%). In adjusted models, persons with intravenous drug use had lower odds of receiving HAART (odds ratio [OR], 0.61 [95% confidence interval {CI}, 0.430-0.87]) than men who have sex with men. Veterans with fewer than 3 visits had lower odds of receiving HAART (OR, 0.08 [95% CI, 0.03-0.20]) and PCP prophylaxis (OR, 0.22 [95% CI, 0.11-0.44). Compared to HCSUS, the VA facilities delivered indicated care in 4 of 5 indicators common to both data sets at a higher rate. • Conclusions: Quality of care for HIV-infected veterans was similar to national benchmarks, although a need for improvement was clear in both samples. Interventions to close gaps in quality of HIV care are indicated, particularly for persons with intravenous drug use and those with less than 3 visits per year.