Chapter 3 - Services Provided to Veterans with HIV/AIDS

Location of Care

The 23,463 Veterans with HIV/AIDS in VHA care in 2008 generated 8,831 inpatient discharges and over 708,000 outpatient visits (Table 1). They filled over 1.6 million prescriptions. Compared to the overall VHA population, Veterans with HIV/AIDS had higher use of some VHA services including hospitalizations and prescription fills. Table 1 shows a comparison of general healthcare utilization in the most recent available year for all Veterans (federal fiscal year 2008) and Veterans in care with HIV/AIDS (calendar year 2008).

With respect to inpatient care, 4,655 HIV infected Veterans had 8,831 discharges in 2008. The average length of stay was 14.6 days with a median of 4 days. The percentage of discharges by major diagnostic groups (where the group accounts for at least one percent of all discharges) is presented in Table 2 for all Veterans and those in VHA care for HIV/AIDS. The groups follow the tabular list of diseases presented in the International Classification of Diseases, 9th revision with the addition of categories for HIV infection and Substance Use and Disorders.

The highest percentage of discharges for HIV infected Veterans carried a mental health primary diagnosis (15.4%) compared to 14.1% for the general VHA population. Veterans with HIV/AIDS had a higher percent of discharges for substance use disorders than the general VHA population (8.2% vs. 6.1%). Veterans with HIV/AIDS also had higher rates of discharges for infectious diseases, excluding inpatient stays for which HIV was the primary diagnosis than the overall VHA Veteran population (5.0% vs. 1.6%). Conversely, the general VHA population had a higher percentage of discharges for diseases of the circulatory system conditions than Veterans with HIV/AIDS (18.7% vs. 9.6%).

Between 2005 and 2008, substance use disorder discharges decreased from 10.2% to 8.2% of all discharges of Veterans with HIV/AIDS. On the other hand, the percentage of discharges for the circulatory system increased in the HIV/AIDS Veteran population from 8.4% to 9.6% in that period. The percentage of discharges with a primary diagnosis of HIV infection decreased by 36% from 13.2% to 8.5% from 2005 to 2008, respectively.

Veterans with HIV/AIDS may be seen for their HIV infection in primary care, infectious disease clinic or a combination of both-depending how care is organized at their local healthcare system. Veterans with HIV/AIDS were actively engaged in VHA care in 2008 with a median of 7 outpatient primary care or infectious disease clinic visits that year. In 2008, 39% of HIV/AIDS Veterans had between 2 and 6 such visits, 35% had between 7 and 12 visits and 20% had over 13 visits in the year. Veterans with HIV/AIDS were seen in nearly all types of clinics in VHA including medicine, surgery, and mental health.

Methods

1. VHA data. The data on the entire veteran population can be found at http://www1.va.gov/vetdata.
2. Diagnostic Subgroup. The distribution of discharges by major diagnostic subgroup was determined using the primary discharge code for each hospitalization using the 17 groups created by the Classification of Diseases and Injuries version ICD-9-CM. Distribution of discharges for the National VA population is based on data from the VA's Decision Support System.
3. Federal fiscal year (FY) covers October 1 through September 30 of the following year. For example, FY2008 runs from October 1, 2007 through September 30, 2008.