HIV Care Coordination promotes care re-engagement and viral suppression among people who have been out of HIV medical care: an observational effectiveness study using a surveillance-based contemporaneous comparison group

Abstract Background Medical care re-engagement is critical to suppressing viral load and preventing HIV transmission, morbidity and mortality, yet few rigorous intervention studies address this outcome. We assessed the effectiveness of a Ryan White Part A-funded HIV Care Coordination Program relative to ‘usual care,’ for short-term care re-engagement and viral suppression among people without recent HIV medical care. Methods The Care Coordination Program was launched in 2009 at 28 hospitals, health centers, and community-based organizations in New York City. Designed for people with HIV (PWH) experiencing or at risk for poor HIV outcomes, the Care Coordination Program provides long-term, comprehensive medical case management utilizing interdisciplinary teams, structured health education and patient navigation. The intervention was implemented as a safety-net services program, without a designated comparison group. To evaluate it retrospectively, we created an observational, matched cohort of clients and controls. Using the HIV surveillance registry, we identified individuals meeting program eligibility criteria from December 1, 2009 to March 31, 2013 and excluded those dying prior to 12 months of follow-up. We then matched clients to controls on baseline status (lacking evidence of viral suppression, consistently suppressed, inconsistently suppressed, or newly diagnosed in the past 12 months), start of follow-up and propensity score. For this analysis, we limited to those out of care at baseline (defined as having no viral load test in the 12 months pre-enrollment) and still residing within jurisdiction (defined as having a viral load or CD4 test reported to local surveillance and dated within the 12-month follow-up period). Using a GEE model with binary error distribution and logit link, we compared odds of care re-engagement (defined as having ≥ 2 laboratory events ≥ 90 days apart) and viral suppression (defined as having HIV RNA ≤ 200 copies/mL on the most recent viral load test) at 12-month follow-up. Results Among 326 individuals out of care at baseline, 87.2% of clients and 48.2% of controls achieved care re-engagement (Odds Ratio: 4.53; 95%CI 2.66, 7.71); 58.3% of clients and 49.3% of controls achieved viral suppression (Odds Ratio: 2.05; 95%CI 1.30, 3.23). Conclusions HIV Care Coordination shows evidence of effectiveness for care and treatment re-engagement.

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The HIV care cascade for adolescents initiated on antiretroviral therapy in a health district of South Africa: a retrospective cohort study

BMC Infectious Diseases ◽

10.1186/s12879-020-05742-9 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Roxanna Haghighat ◽

Elona Toska ◽

Nontuthuzelo Bungane ◽

Lucie Cluver

Keyword(s):

South Africa ◽

Viral Load ◽

Antiretroviral Therapy ◽

Viral Suppression ◽

Hiv Care ◽

Loss To Follow Up ◽

Hiv Care Cascade ◽

Care Cascade ◽

Clinical Records

Abstract Background Little evidence exists to comprehensively estimate adolescent viral suppression after initiation on antiretroviral therapy in sub-Saharan Africa. This study examines adolescent progression along the HIV care cascade to viral suppression for adolescents initiated on antiretroviral therapy in South Africa. Methods All adolescents ever initiated on antiretroviral therapy (n=1080) by 2015 in a health district of the Eastern Cape, South Africa, were interviewed in 2014–2015. Clinical records were extracted from 52 healthcare facilities through January 2018 (including records in multiple facilities). Mortality and loss to follow-up rates were corrected for transfers. Predictors of progression through the HIV care cascade were tested using sequential multivariable logistic regressions. Predicted probabilities for the effects of significant predictors were estimated by sex and mode of infection. Results Corrected mortality and loss to follow-up rates were 3.3 and 16.9%, respectively. Among adolescents with clinical records, 92.3% had ≥1 viral load, but only 51.1% of viral loads were from the past 12 months. Adolescents on ART for ≥2 years (AOR 3.42 [95%CI 2.14–5.47], p< 0.001) and who experienced decentralised care (AOR 1.39 [95%CI 1.06–1.83], p=0.018) were more likely to have a recent viral load. The average effect of decentralised care on recent viral load was greater for female (AOR 2.39 [95%CI 1.29–4.43], p=0.006) and sexually infected adolescents (AOR 3.48 [95%CI 1.04–11.65], p=0.043). Of the total cohort, 47.5% were recorded as fully virally suppressed at most recent test. Only 23.2% were recorded as fully virally suppressed within the past 12 months. Younger adolescents (AOR 1.39 [95%CI 1.06–1.82], p=0.017) and those on ART for ≥2 years (AOR 1.70 [95%CI 1.12–2.58], p=0.013) were more likely to be fully viral suppressed. Conclusions Viral load recording and viral suppression rates remain low for ART-initiated adolescents in South Africa. Improved outcomes for this population require stronger engagement in care and viral load monitoring.

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High Rates of Retention and Viral Suppression in the US HIV Safety Net System: HIV Care Continuum in the Ryan White HIV/AIDS Program, 2011

Clinical Infectious Diseases ◽

10.1093/cid/ciu722 ◽

2014 ◽

Vol 60 (1) ◽

pp. 117-125 ◽

Cited By ~ 66

Author(s):

R. K. Doshi ◽

J. Milberg ◽

D. Isenberg ◽

T. Matthews ◽

F. Malitz ◽

...

Keyword(s):

Viral Suppression ◽

Safety Net ◽

Hiv Care ◽

Hiv Care Continuum ◽

Care Continuum ◽

Ryan White ◽

The Us ◽

Aids Program ◽

Hiv Aids

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Implementing a Data to Care Strategy to Improve Health Outcomes for People With HIV: A Report From the Care and Prevention in the United States Demonstration Project

Public Health Reports ◽

10.1177/0033354918805987 ◽

2018 ◽

Vol 133 (2_suppl) ◽

pp. 60S-74S ◽

Cited By ~ 13

Author(s):

Patricia Sweeney ◽

Tamika Hoyte ◽

Mesfin S. Mulatu ◽

Jacquelyn Bickham ◽

Antoine D. Brantley ◽

...

Keyword(s):

United States ◽

Health Outcomes ◽

Medical Care ◽

Treatment Adherence ◽

Viral Suppression ◽

The United States ◽

Health Departments ◽

State Health ◽

Improve Health

Objectives: The Care and Prevention in the United States Demonstration Project included implementation of a Data to Care strategy using surveillance and other data to (1) identify people with HIV infection in need of HIV medical care or other services and (2) facilitate linkages to those services to improve health outcomes. We present the experiences of 4 state health departments: Illinois, Louisiana, Tennessee, and Virginia. Methods: The 4 state health departments used multiple databases to generate listings of people with diagnosed HIV infection (PWH) who were presumed not to be in HIV medical care or who had difficulty maintaining viral suppression from October 1, 2013, through September 29, 2016. Each health department prioritized the listings (eg, by length of time not in care, by viral load), reviewed them for accuracy, and then disseminated the listings to staff members to link PWH to HIV care and services. Results: Of 16 391 PWH presumed not to be in HIV medical care, 9852 (60.1%) were selected for follow-up; of those, 4164 (42.3%) were contacted, and of those, 1479 (35.5%) were confirmed to be not in care. Of 794 (53.7%) PWH who accepted services, 694 (87.4%) were linked to HIV medical care. The Louisiana Department of Health also identified 1559 PWH as not virally suppressed, 764 (49.0%) of whom were eligible for follow-up. Of the 764 PWH who were eligible for follow-up, 434 (56.8%) were contacted, of whom 269 (62.0%) had treatment adherence issues. Of 153 PWH who received treatment adherence services, 104 (68.0%) showed substantial improvement in viral suppression. Conclusions: The 4 health departments established procedures for using surveillance and other data to improve linkage to HIV medical care and health outcomes for PWH. To be effective, health departments had to enhance coordination among surveillance, care programs, and providers; develop mechanisms to share data; and address limitations in data systems and data quality.

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Determination of the influence of predictors and the probability of retinal detachment in children based on the analysis of the odds ratio

Doklady BGUIR ◽

10.35596/1729-7648-2021-19-7-106-109 ◽

2021 ◽

Vol 19 (7) ◽

pp. 106-109

Author(s):

H. A. Sushchenia

Keyword(s):

Retinal Detachment ◽

Odds Ratio ◽

Comparison Group ◽

Significant Risk ◽

Preventive Treatment ◽

Risk Groups ◽

Vitreoretinal Interface ◽

Clinical Hospital

The analysis of the influence of predictors on the probability of retinal detachment in children of the Minsk region was carried out on the basis of a study of the medical records of 660 children's patients treated at the Health care Institutions "4th Children's City Clinical Hospital" and “Minsk Regional Children's Clinical Hospital” for the period 2009–2019. Of these, 313 patients were older than 1 year with an established diagnosis of retinal detachment, 107 children under the age of 1 year, 240 children older than 1 year without retinal detachment at the time of treatment and the presence of predictors of its development (comparison group). To assess the influence of factors, a methodology based on the calculation of the odds ratio was used. The most significant risk factors were assigned a score equivalent from one to four, which allowed quantifying the probability of retinal detachment and identifying risk groups depending on the total score. The use of the proposed method allowed the children of the comparison group to identify changes in the vitreoretinal interface, which required primary laser preventive treatment in 46.7% of cases (113 eyes) during the three-year follow-up period, in 45.4% of children (109 eyes) it was limited only to dynamic observation without treatment. In 95.0% of children in the comparison group, it was possible to prevent the development of retinal detachment.

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Pilot Program of Shared Assistance with Primary Care in Patients Living with HIV, and Satisfaction with The Healthcare Received

10.21203/rs.3.rs-576992/v1 ◽

2021 ◽

Author(s):

Melchor Riera ◽

Adria Ferre ◽

Alfredo Santos-Pinheiro ◽

Helem Hayde Vilchez ◽

Maria Luisa Martin-Peña ◽

...

Keyword(s):

Health Care ◽

Primary Health Care ◽

Viral Load ◽

Hiv Infection ◽

Shared Care ◽

Hiv Care ◽

Pilot Program ◽

Art Adherence ◽

Primary Health

Abstract Background: There are few shared assistance programs with Primary Health Care (PHC) in PLWH. The aim was to develop a Pilot Program of shared HIV care in PLWH ensuring proper HIV control. Methods: Design: Prospective pilot project of a shared care intervention.Setting: HIV specialized outpatient consultations for HIV infection at Son Espases University Hospital which serves 2000 patients. Subjects: Patients who attended HIV specialized consultation between January 1st and June 30th, 2017. Intervention: Basal questionnaire on health services used by patients. HIV Training Program on HIV in Primary Health Care (PHC). Pilot Program of shared assistance (PPAC) with PHC. Main Outcomes: Maintenance of undetectable HIV viral load, antiretroviral therapy (ART) adherence, AIDS and non-AIDS events, loss of follow up, and satisfaction questionnaire. Results: The basal questionnaire was filled out by 918 patients, with 108 (11.7%) patients reporting neither knowing nor having been visited by their GP. A total of 93 patients were included in the PPAC, with a mean age of 49.9 years (SD 11.7), and an average of 14.6 years since the HIV diagnosis. Eleven patients were followed up for less than six months and were excluded from the analysis. Median follow-up during the PPAC of the remaining 82 patients was 728 days (IQR 370-1070). Sixteen patients dropped out of the PPAC (19.5%), three died, three were lost to follow up, one was withdrawn due to medical criteria, and nine withdrew voluntarily.No patient presented any AIDS defining events, although eight patients presented non-AIDS events. All the patients had undetectable viral load (VL) and average ART adherence was 99.4% (SD1.4). The patient’s satisfaction score with PPAC was 8.64 (SD2.5).Conclusion: It is possible to establish shared care programs with PHC in selected patients with HIV infection, thereby reducing hospital visits while maintaining good adherence and virological control and achieving high patient satisfaction.

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Rapid Antiretroviral Therapy (ART) Initiation at a Community-Based Clinic in Jackson, MS

AIDS Research and Therapy ◽

10.1186/s12981-020-00319-7 ◽

2020 ◽

Vol 17 (1) ◽

Author(s):

Courtney E. Sims Gomillia ◽

Kandis V. Backus ◽

James B. Brock ◽

Sandra C. Melvin ◽

Jason J. Parham ◽

...

Keyword(s):

Viral Load ◽

Antiretroviral Therapy ◽

Median Time ◽

Viral Suppression ◽

Hiv Care ◽

Virologic Suppression ◽

Community Based ◽

Art Initiation ◽

Healthcare Center ◽

The Impact

Abstract Background Rapid antiretroviral therapy (ART), ideally initiated within twenty-four hours of diagnosis, may be crucial in efforts to increase virologic suppression and reduce HIV transmission. Recent studies, including demonstration projects in large metropolitan areas such as Atlanta, Georgia; New Orleans, Louisiana; San Francisco, California; and Washington D.C., have demonstrated that rapid ART initiation is a novel tool for expediting viral suppression in clinical settings. Here we present an evaluation of the impact of a rapid ART initiation program in a community-based clinic in Jackson, MS. Methods We conducted a retrospective chart review of patients who were diagnosed with HIV at Open Arms Healthcare Center or were linked to the clinic for HIV care by the Mississippi State Department of Health Disease Intervention Specialists from January 1, 2016 to December 31, 2018. Initial viral load, CD4+ T cell count, issuance of an electronic prescription (e-script), subsequent viral loads until suppressed and patient demographics were collected for each individual seen in clinic during the review period. Viral suppression was defined as a viral load less than 200 copies/mL. Rapid ART initiation was defined as receiving an e-script for antiretrovirals within seven days of diagnosis. Results Between January 1, 2016 and December 31, 2018, 70 individuals were diagnosed with HIV and presented to Open Arms Healthcare Center, of which 63 (90%) completed an initial HIV counseling visit. Twenty-seven percent of patients were provided with an e-script for ART within 7 days of diagnosis. The median time to linkage to care for this sample was 12 days and 5.5 days for rapid ART starters (p < 0.001). Median time from diagnosis to viral suppression was 55 days for rapid ART starters (p = 0.03), a 22 day decrease from standard time to viral suppression. Conclusion Our results provide a similar level of evidence that rapid ART initiation is effective in decreasing time to viral suppression. Evidence from this evaluation supports the use of rapid ART initiation after an initial HIV diagnosis, including same-day treatment.

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The cost and effect of expanding a Patient Tracer programme to identify and return patients loss to follow up at a large HIV Clinic in Trinidad

10.21203/rs.3.rs-41913/v1 ◽

2020 ◽

Author(s):

R. Jeffrey Edwards ◽

Nyla Lyons ◽

Wendy Samaroo-Francis ◽

Leon-Omari Lavia ◽

Isshad John ◽

...

Keyword(s):

Viral Suppression ◽

Hiv Care ◽

Loss To Follow Up ◽

Treatment Clinic ◽

The Status ◽

Clinic Medical ◽

The Cost ◽

Lost To Follow Up ◽

Over Time

Abstract Background: Patients who default from HIV care are usually poorly adherent to antiretroviral treatment which results in suboptimal viral suppression. The study evaluated the effect and cost of expanding an intervention using two Patient Tracers to track and return to care patients lost to follow up at a large HIV Clinic in Trinidad.Methods: Two Social Workers were trained as Patient Tracers and hired initially for 6 months (April –September 2017), then extended to 15 months (April 2017 – June 2018) to call patients who were lost to follow up for 30 days or more during the period July 2016 – May 2018 at the HIV Clinic Medical Research Foundation of Trinidad and Tobago. Both the outcomes of the intervention, and costs were assessed over time. Results: Over the 15 month period, of the of 2,473 patients who missed their scheduled visits for one month or more, 261 (10.6%) patients were no longer in active care - 89 patients dead, 65 migrated, 55 hospitalized, 33 transferred to another treatment clinic and 19 incarcerated. Of the remaining 2,212 patients eligible for tracing, 1,794 (81.1%) patients were returned to care at an average cost of $38.09 USD per patient returned to care as compared to 589 of 866 (68%) patients returned to care over the 6 month period (p < 0.001) at an estimated cost of $47.72 USD per patient returned to care (p<0.001). Of the 1,794 patients returned to care, 1,686 (94%) were re-initiated/started on anti-retroviral therapy and 72.7% of these were virally suppressed (viral load <1,000 copies/ml) as of December 2018.Conclusions: Patient Tracing is a feasible and effective intervention to identify and resolve the status of patients who are loss to follow up to bring these patients back into care with the aim of achieving viral suppression on antiretroviral therapy. Over time the effect of costs of patients returned to care demonstrated greater yields making patient tracing a sustainable intervention for programmes to identify and return patients to care.

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Short-term effectiveness of HIV care coordination among persons with recent HIV diagnosis or history of poor HIV outcomes

10.1101/311597 ◽

2018 ◽

Author(s):

Denis Nash ◽

McKaylee M. Robertson ◽

Kate Penrose ◽

Stephanie Chamberlin ◽

Rebekkah S. Robbins ◽

...

Keyword(s):

New York ◽

New York City ◽

Viral Load ◽

Relative Risk ◽

York City ◽

Hiv Care ◽

Newly Diagnosed ◽

Viral Load Suppression ◽

History Of

AbstractThe New York City HIV Care Coordination Program (CCP) combines multiple evidence-based strategies to support persons living with HIV (PLWH) at risk for, or with a recent history of, poor HIV outcomes. We assessed the comparative effectiveness of the CCP by merging programmatic data on CCP clients with population-based surveillance data on all New York City PLWH. A non-CCP comparison group of similar PLWH who met CCP eligibility criteria was identified using surveillance data. The CCP and non-CCP groups were matched on propensity for CCP enrollment within four baseline treatment status groups (newly diagnosed or previously diagnosed and either consistently unsuppressed, inconsistently suppressed or consistently suppressed). We compared CCP to non-CCP proportions with viral load suppression at 12-month follow-up. Among the 13,624 persons included, 15·3% were newly diagnosed; among the 84·7% previously diagnosed, 14·2% were consistently suppressed, 28·9% were inconsistently suppressed, and 41 ·6% were consistently unsuppressed in the year prior to baseline. At 12-month follow-up, 59·9% of CCP and 53·9% of non-CCP participants had viral load suppression (Relative Risk=1.11, 95%CI:1.08-1.14). Among those newly diagnosed and those consistently unsuppressed at baseline, the relative risk of viral load suppression in the CCP versus non-CCP participants was 1.15 (95%CI:1.09-1.23) and 1.32 (95%CI:1.23-1.42), respectively. CCP exposure shows benefits over no CCP exposure for persons newly diagnosed or consistently unsuppressed, but not for persons suppressed in the year prior to baseline. We recommend more targeted case finding for CCP enrollment and increased attention to viral load suppression maintenance.

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A modified HIV continuum of care: A six-year evaluation of a viral load cascade at a hospital-based clinic in Kingston, Jamaica

International Journal of STD & AIDS ◽

10.1177/0956462419839514 ◽

2019 ◽

Vol 30 (8) ◽

pp. 748-755 ◽

Cited By ~ 1

Author(s):

Geoffrey J Barrow ◽

Margaret L Brandeau

Keyword(s):

Viral Load ◽

Statistical Analysis ◽

Viral Suppression ◽

Care Delivery ◽

Continuum Of Care ◽

Hiv Care ◽

Viral Load Suppression ◽

Outcome Indicators ◽

Care Continuum ◽

Hiv Continuum Of Care

To achieve the goal of HIV viral suppression, provision of medication alone is not sufficient. Concomitant frameworks to evaluate HIV care delivery programmes are needed. This study examined the care continuum at a hospital-based HIV clinic in Kingston, Jamaica using a modified HIV continuum of care, with an increased focus on viral load indicators (viral load samples taken, results returned and viral suppression). A statistical analysis of patient flow through the care continuum to identify gaps in programme delivery was performed. Key programmatic areas for process improvement and the utility of this approach for viral load suppression interpretation were identified. Between 2010 and 2015, more than 1600 patients had been registered for care and more than 1000 had accessed antiretroviral therapy at this location. Consistent trends in programme performance were seen from 2010 to 2012. Although declines in the proportion of viral load samples taken and results returned occurred because of laboratory failures in 2013, the trend of increasing numbers and proportions of virally suppressed patients continued. Statistical analysis indicated that improvements in laboratory quality (fraction of viral load samples returned with accurate test results) could increase viral load suppression among patients at the clinic by up to 17%. Refining care delivery processes can significantly improve HIV viral load suppression rates. Expanding monitoring frameworks to include all of the essential processes that affect final outcome indicators can provide valuable insight into trends of outcome indicators and programme performance.

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