Role of acupuncture as an adjuvant therapy in the treatment of HIV/AIDS: Examining disparities in access, cost-effectiveness of using acupuncture as a promoter of adherence to antiretroviral treatment, and public health considerations

Background: The use of acupuncture in the U.S. by individuals living with HIV/AIDS represents a new area of clinical and academic study. Since many individuals turn to acupuncture for relief of side-effects related to their use of antiretroviral medication, examining this aspect of care is of special therapeutic, public health, and economic interest. In the three papers of this dissertation, I address the use of acupuncture as an adjuvant to medical care, particularly focused on its role in side-effect management and promoting medication adherence. Concomitant economic ramifications and interdependencies between quality of life and treatment adherence are also explored, as well as potential disparities in access to acupuncture related to changes in federal funding.;Methods: The first paper (Dynamic Interplay of Adherence to HIV-medication, Quality of Life, and Side Effect Management) examines a conceptual model that may be useful for understanding these dynamic inter-relationships. The second paper (Cost-effectiveness of Acupuncture to Improve and Sustain Adherence to Antiretroviral Therapy) explores cost-effectiveness of enhanced adherence and compares associated costs and health outcomes resulting from using acupuncture in order to optimize adherence to antiretroviral therapy. The last paper (Examining Changes in Utilization of Acupuncture Care Related to Reduction in Ryan White Care Act Funding) addresses the issue of utilization and uses bivariate and multivariate analyses to explore disparities associated with demographic and behavioral issues. Both the second and third papers use data from retrospective medical record review.;Results: Records of approximately 1100 patients were included in the analyses. Cost-effectiveness estimates were found to be consistent with costs of other interventions to promote adherence to antiretroviral therapy previously reported in the literature. Although disparities in utilization of acupuncture were noted for female patients and for those reporting use of alcohol, small sample size may have hampered the study's ability to detect meaningful differences.;Recommendations: The use of acupuncture as an adjuvant to HIV/AIDS care merits clinical and research interest. Although limitations of these analyses were evident, results indicate that acupuncture may offer therapeutic benefit through promoting adherence to antiretroviral therapy. Continued outreach services for all aspects of care to women living with HIV/AIDS seemingly remain important.