scholarly journals Adherence and Viral Suppression Among Participants of the Patient-centered Human Immunodeficiency Virus (HIV) Care Model Project: A Collaboration Between Community-based Pharmacists and HIV Clinical Providers

2019 ◽  
Author(s):  
Kathy K Byrd ◽  
John G Hou ◽  
Tim Bush ◽  
Ron Hazen ◽  
Heather Kirkham ◽  
...  
Keyword(s):  
Human Immunodeficiency Virus ◽  
Viral Suppression ◽  
Hiv Care ◽  
Care Model ◽  
Patient Centered ◽  
Community Based ◽  
Immunodeficiency Virus ◽  
Model Project

scholarly journals 1769. Viral Suppression Among Participants of the Patient-Centered HIV Care Model Project—A Collaboration Between Community-Based Pharmacists and HIV Clinical Providers

2018 ◽  
Vol 5 (suppl_1) ◽  
pp. S65-S65
Author(s):  
Kathy Byrd ◽  
John Hou ◽  
Patrick Clay ◽  
Tim Bush ◽  
Ambrose Delpino ◽  
...  
Keyword(s):  
Viral Load ◽  
Viral Suppression ◽  
Community Pharmacists ◽  
Hiv Care ◽  
Care Model ◽  
Patient Centered ◽  
Community Based ◽  
Medication Therapy ◽  
Persons Living With Hiv ◽  
Measurement Period

Abstract Background The patient-centered HIV care model was developed to integrate community pharmacists with HIV clinical providers to deliver patient-centered HIV care. The project required 10 clinics to share, with their partnered community-based pharmacists, patients’ medical histories, laboratory results, and medications. Pharmacists reviewed the clinic data and worked directly with participants and/or their partnered clinics to make recommendations and discuss potential intervention strategies for identified therapy-related problems. Methods We calculated the proportion of persons virally suppressed (<200 copies/mL at the last test in each of two 12-month measurement periods), pre- and post-model implementation. Included in the analysis were persons with ≥1 HIV viral load in each measurement period. McNemar’s test was used to compare the proportion virally suppressed, pre- and postimplementation. Multivariable logistic regression was used to determine factors associated with viral suppression, postimplementation. Participant demographics and the proportion of days covered (PDC; a measure used to calculate adherence to medication therapy) were used as explanatory variables in the model. The PDC was modified to account for the time to the last viral load in the measurement period, and was stratified into 4 categories: ≥90%, <90–80%, <80–50%, and <50%. Results With 765 persons enrolled, the plurality of those included in the analysis (n = 648) were non-Hispanic black (n = 286), male (n = 470), and had a median age of 49 years (IQR=38–56). Viral suppression improved 16.3% from 73.9% to 85.9%, pre- to postimplementation (P < 0.001). Persons who had higher modified PDC (OR 1.9 per category level; 95% CI 1.4–2.6), were currently employed (OR 4.1; 1.6–12.8), or age >50 years (OR 4.7; 2.1–11.8), had greater odds of being suppressed. Non-Hispanic black persons were less likely to be suppressed (OR 0.2; 0.1–0.6); however, viral suppression among this group improved from 62.5% to 77.6%, pre- to postimplementation (P < 0.001). Conclusion Collaborations between community pharmacists and HIV clinic providers that seek to identify and address HIV therapy-related problems can lead to improved viral suppression among persons living with HIV. Disclosures P. Clay, Jaguar Health, Inc.: Consultant and Speaker’s Bureau, Consulting fee and Speaker honorarium. Merck & Co., Inc.: Investigator, Research grant. A. Delpino, Walgreens: Employee and Shareholder, Salary.

scholarly journals Costs and Cost-Effectiveness of the Patient-Centered HIV Care Model: A Collaboration Between Community-Based Pharmacists and Primary Medical Providers

2020 ◽  
Vol 85 (3) ◽  
pp. e48-e54 ◽  
Author(s):  
Ram K. Shrestha ◽  
Jon C. Schommer ◽  
Michael S. Taitel ◽  
Oscar W. Garza ◽  
Nasima M. Camp ◽  
...  
Keyword(s):  
Cost Effectiveness ◽  
Hiv Care ◽  
Medical Providers ◽  
Care Model ◽  
Patient Centered ◽  
Community Based

scholarly journals Retention in HIV Care Among Participants in the Patient-Centered HIV Care Model: A Collaboration Between Community-Based Pharmacists and Primary Medical Providers

2019 ◽  
Vol 33 (2) ◽  
pp. 58-66 ◽  
Author(s):  
Kathy K. Byrd ◽  
Felicia Hardnett ◽  
Patrick G. Clay ◽  
Ambrose Delpino ◽  
Ron Hazen ◽  
...  
Keyword(s):  
Hiv Care ◽  
Medical Providers ◽  
Care Model ◽  
Patient Centered ◽  
Community Based ◽  
Retention In Hiv Care

scholarly journals Human Immunodeficiency Virus (HIV) Quality Indicators Are Similar Across HIV Care Delivery Models

2017 ◽  
Vol 4 (1) ◽  
Author(s):  
Corinne M. Rhodes ◽  
Yuchiao Chang ◽  
Susan Regan ◽  
Daniel E. Singer ◽  
Virginia A. Triant
Keyword(s):  
Infectious Disease ◽  
Human Immunodeficiency Virus ◽  
Quality Indicators ◽  
Care Delivery ◽  
Quality Measures ◽  
Hiv Care ◽  
Care Model ◽  
Hiv Management ◽  
Immunodeficiency Virus ◽  
Care Models

Abstract Background There are limited data on human immunodeficiency virus (HIV) quality indicators according to model of HIV care delivery. Comparing HIV quality indicators by HIV care model could help inform best practices because patients achieving higher levels of quality indicators may have a mortality benefit. Methods Using the Partners HIV Cohort, we categorized 1565 patients into 3 HIV care models: infectious disease provider only (ID), generalist only (generalist), or infectious disease provider and generalist (ID plus generalist). We examined 12 HIV quality indicators used by 5 major medical and quality associations and grouped them into 4 domains: process, screening, immunization, and HIV management. We used generalized estimating equations to account for most common provider and multivariable analyses adjusted for prespecified covariates to compare composite rates of HIV quality indicator completion. Results We found significant differences between HIV care models, with the ID plus generalists group achieving significantly higher quality measures than the ID group in HIV management (94.4% vs 91.7%, P = .03) and higher quality measures than generalists in immunization (87.8% vs 80.6%, P = .03) in multivariable adjusted analyses. All models achieved rates that equaled or surpassed previously reported quality indicator rates. The absolute differences between groups were small and ranged from 2% to 7%. Conclusions Our results suggest that multiple HIV care models are effective with respect to HIV quality metrics. Factors to consider when determining HIV care model include healthcare setting, feasibility, and physician and patient preference.

scholarly journals Initiation of Antiretroviral Therapy in the Hospital Is Associated With Linkage to Human Immunodeficiency Virus (HIV) Care for Persons Living With HIV and Substance Use Disorder

2020 ◽  
Author(s):  
Petra Jacobs ◽  
Daniel J Feaster ◽  
Yue Pan ◽  
Lauren K Gooden ◽  
Eric S Daar ◽  
...  
Keyword(s):  
Human Immunodeficiency Virus ◽  
Substance Use ◽  
Outpatient Care ◽  
Viral Suppression ◽  
Hiv Care ◽  
Art Initiation ◽  
Persons Living With Hiv ◽  
Immunodeficiency Virus ◽  
Linkage To Hiv Care ◽  
Living With Hiv

Abstract Background Studies have demonstrated benefits of antiretroviral therapy (ART) initiation on the day of human immunodeficiency virus (HIV) testing or at first clinical visit. The hospital setting is understudied for immediate ART initiation. Methods CTN0049, a linkage-to-care randomized clinical trial, enrolled 801 persons living with HIV (PLWH) and substance use disorder (SUD) from 11 hospitals across the United States. This secondary analysis examined factors related to initiating (including reinitiating) ART in the hospital and its association with linkage to HIV care, frequency of outpatient care visits, retention, and viral suppression. Results Of 801 participants, 124 (15%) initiated ART in the hospital, with more than two-thirds of these participants (80/124) initiating ART for the first time. Time to first HIV care visit among those who initiated ART in the hospital and those who did not was 29 and 54 days, respectively (P = .0145). Hospital initiation of ART was associated with increased frequency of HIV outpatient care visits at 6 and 12 months. There was no association with ART initiation in the hospital and retention and viral suppression over a 12-month period. Participants recruited in Southern hospitals were less likely to initiate ART in the hospital (P < .001). Conclusions Previous research demonstrated benefits of immediate ART initiation, yet this approach is not widely implemented. Research findings suggest that starting ART in the hospital is beneficial for increasing linkage to HIV care and frequency of visits for PLWH and SUD. Implementation research should address barriers to early ART initiation in the hospital.

scholarly journals Characterizing the Human Immunodeficiency Virus Care Continuum Among Transgender Women and Cisgender Women and Men in Clinical Care: A Retrospective Time-series Analysis

2019 ◽  
Vol 70 (6) ◽  
pp. 1131-1138 ◽  
Author(s):  
Tonia Poteat ◽  
David B Hanna ◽  
Peter F Rebeiro ◽  
Marina Klein ◽  
Michael J Silverberg ◽  
...  
Keyword(s):  
Human Immunodeficiency Virus ◽  
Hiv Risk ◽  
Viral Suppression ◽  
Risk Group ◽  
Retention In Care ◽  
Hiv Care ◽  
Hiv Care Continuum ◽  
Care Continuum ◽  
Immunodeficiency Virus ◽  
Over Time

Abstract Background Prior studies suggest that transgender women (TW) with human immunodeficiency virus (HIV) are less likely to be virally suppressed than cisgender women (CW) and cisgender men (CM). However, prior data are limited by small sample sizes and cross-sectional designs. We sought to characterize the HIV care continuum comparing TW to CW and CM in the United States and Canada. Methods We analyzed annual HIV care continuum outcomes by gender status from January 2001 through December 2015 among adults (aged ≥18 years) in 15 clinical cohorts. Outcomes were retention in care and viral suppression. Results The study population included TW (n = 396), CW (n = 14 094), and CM (n = 101 667). TW had lower proportions retained in care than CW and CM (P < .01). Estimates of retention in care were consistently lower in TW, with little change over time within each group. TW and CW had similar proportions virally suppressed over time (TW, 36% in 2001 and 80% in 2015; CW, 35% in 2001 and 83% in 2015) and were lower than CM (41% in 2001 and 87% in 2015). These differences did not reach statistical significance after adjusting for age, race, HIV risk group, and cohort. Conclusions TW experience challenges with retention in HIV care. However, TW who are engaged in care achieve viral suppression that is comparable to that of CW and CM of similar age, race, and HIV risk group. Further research is needed to understand care engagement disparities.

scholarly journals Optimizing Human Immunodeficiency Virus Testing Interventions for Men Who Have Sex With Men in the United States: A Modeling Study

2015 ◽  
Vol 2 (4) ◽  
Author(s):  
Kevin P. Delaney ◽  
Eli S. Rosenberg ◽  
Michael R. Kramer ◽  
Lance A. Waller ◽  
Patrick S. Sullivan
Keyword(s):  
United States ◽  
Human Immunodeficiency Virus ◽  
Hiv Testing ◽  
Viral Suppression ◽  
The United States ◽  
Hiv Care ◽  
Hiv Incidence ◽  
Test Sensitivity ◽  
Immunodeficiency Virus ◽  
Sex With Men

Abstract Background.  In the United States, public health recommendations for men who have sex with men (MSM) include testing for human immunodeficiency virus (HIV) at least annually. We model the impact of different possible HIV testing policies on HIV incidence in a simulated population parameterized to represent US MSM. Methods.  We used exponential random graph models to explore, among MSM, the short-term impact on baseline (under current HIV testing practices and care linkage) HIV incidence of the following: (1) increasing frequency of testing; (2) increasing the proportion who ever test; (3) increasing test sensitivity; (4) increasing the proportion of the diagnosed population achieving viral suppression; and combinations of 1–4. We simulated each scenario 20 times and calculated the median and interquartile range of 3-year cumulative incidence of HIV infection. Results.  The only intervention that reduced HIV incidence on its own was increasing the proportion of the diagnosed population achieving viral suppression; increasing frequency of testing, the proportion that ever test or test sensitivity did not appreciably reduce estimated incidence. However, in an optimal scenario in which viral suppression improved to 100%, HIV incidence could be reduced by an additional 17% compared with baseline by increasing testing frequency to every 90 days and test sensitivity to 22 days postinfection. Conclusions.  Increased frequency, coverage, or sensitivity of HIV testing among MSM is unlikely to result in reduced HIV incidence unless men diagnosed through enhanced testing programs are also engaged in effective HIV care resulting in viral suppression at higher rates than currently observed.

scholarly journals Achieving Viral Suppression in 90% of People Living With Human Immunodeficiency Virus on Antiretroviral Therapy in Low- and Middle-Income Countries: Progress, Challenges, and Opportunities

2018 ◽  
Vol 66 (10) ◽  
pp. 1487-1491 ◽  
Author(s):  
Jean B Nachega ◽  
Nadia A Sam-Agudu ◽  
Lynne M Mofenson ◽  
Mauro Schechter ◽  
John W Mellors
Keyword(s):  
Human Immunodeficiency Virus ◽  
Viral Suppression ◽  
Cost Effective ◽  
Term Treatment ◽  
Middle Income ◽  
Middle Income Countries ◽  
Long Term Treatment ◽  
Wide Range ◽  
Immunodeficiency Virus ◽  
Low And Middle Income

Abstract Although significant progress has been made, the latest data from low- and middle-income countries show substantial gaps in reaching the third “90%” (viral suppression) of the UNAIDS 90-90-90 goals, especially among vulnerable and key populations. This article discusses critical gaps and promising, evidence-based solutions. There is no simple and/or single approach to achieve the last 90%. This will require multifaceted, scalable strategies that engage people living with human immunodeficiency virus, motivate long-term treatment adherence, and are community-entrenched and ‑supported, cost-effective, and tailored to a wide range of global communities.

Sign in / Sign up

Export Citation Format

Share Document