Impact of ryan white funding on pediatric HIV/AIDS morbidity and mortality

The impact of Ryan White CARE (RWCA) funding on clinical outcomes of children followed from 1985-1999 in the infectious diseases clinic of a large urban hospital was studied. Data were drawn from computer databases and chart abstraction. Hierarchical logistic regression was used to analyze the impact of temporal effects. RWCA funding resulted in delivery of service to a minority population of women and children and improved access to care as measured by enrollment in prenatal care and for children, age at first visit. Funding was also associated with phase-related declines in rate of development of mild symptoms; progression from asymptomatic to AIDS; proportion aged > 30 days at 1st visit; CD4% loss; mortality rate; and increase in prenatal antiretroviral therapy. Unexpectedly, cognitive function declined from age 13 onward. Cognitive delay is likely exacerbated by the socio-emotional and physical strain of parental HIV-infection. Future Ryan White goals need to address the mental health needs of infected children, those of their affected siblings, and those of children of infected adults.