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Monroe AK, Happ LP, Rayeed N, Ma Y, Jaurretche MJ, Terzian AS, Trac K, Horberg MA, Greenberg AE, Castel AD. Clinic-Level Factors Associated With Time to Antiretroviral Initiation and Viral Suppression in a Large, Urban Cohort. Clin Infect Dis 2020; 71:e151-e158. [PMID: 31701144 PMCID: PMC7583410 DOI: 10.1093/cid/ciz1098] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2019] [Accepted: 11/06/2019] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Using the results of a site assessment survey performed at clinics throughout Washington, DC, we studied the impact of clinic-level factors on antiretroviral therapy (ART) initiation and viral suppression (VS) among people living with human immunodeficiency virus (HIV; PLWH). METHODS This was a retrospective analysis from the District of Columbia (DC) Cohort, an observational, clinical cohort of PLWH from 2011-2018. We included data from PLWH not on ART and not virally suppressed at enrollment. Outcomes were ART initiation and VS (HIV RNA < 200 copies/mL). A clinic survey captured information on care delivery (eg, clinical services, adherence services, patient monitoring services) and clinic characteristics (eg, types of providers, availability of evenings/weekends sessions). Multivariate marginal Cox regression models were generated to identify those factors associated with the time to ART initiation and VS. RESULTS Multiple clinic-level factors were associated with ART initiation, including retention in care monitoring and medication dispensing reviews (adjusted hazard ratios [aHRs], 1.34 to 1.40; P values < .05 for both). Furthermore, multiple factors were associated with VS, including retention in HIV care monitoring, medication dispensing reviews, and the presence of a peer interventionist (aHRs, 1.35 to 1.72; P values < .05 for all). In multivariable models evaluating different combinations of clinic-level factors, enhanced adherence services (aHR, 1.37; 95% confidence interval [CI], 1.18-1.58), medication dispensing reviews (aHR, 1.22; 95% CI, 1.10-1.36), and the availability of opioid treatment (aHR, 1.26; 95% CI, 1.01-1.57) were all associated with the time to VS. CONCLUSIONS The observed association between clinic-level factors and ART initiation/VS suggests that the presence of specific clinic services may facilitate the achievement of HIV treatment goals.
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Affiliation(s)
- Anne K Monroe
- Department of Epidemiology, Milken Institute School of Public Health, The George Washington University, Washington, DC, USA
| | - Lindsey P Happ
- Department of Epidemiology, Milken Institute School of Public Health, The George Washington University, Washington, DC, USA
| | | | - Yan Ma
- Department of Biostatistics, Milken Institute School of Public Health, The George Washington University, Washington, DC, USA
| | - Maria J Jaurretche
- Department of Epidemiology, Milken Institute School of Public Health, The George Washington University, Washington, DC, USA
| | - Arpi S Terzian
- Department of Epidemiology, Milken Institute School of Public Health, The George Washington University, Washington, DC, USA
| | - Kevin Trac
- Department of Epidemiology, Milken Institute School of Public Health, The George Washington University, Washington, DC, USA
| | - Michael A Horberg
- Mid-Atlantic Permanente Research Institute, Kaiser Permanente Mid-Atlantic States, Rockville, Maryland, USA
| | - Alan E Greenberg
- Department of Epidemiology, Milken Institute School of Public Health, The George Washington University, Washington, DC, USA
| | - Amanda D Castel
- Department of Epidemiology, Milken Institute School of Public Health, The George Washington University, Washington, DC, USA
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Heterogeneity in the costs of medical care among people living with HIV/AIDS in the United States. AIDS 2019; 33:1491-1500. [PMID: 30950881 DOI: 10.1097/qad.0000000000002220] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE The costs of medical care for people with HIV/AIDS (PWH) vary substantially across demographic groups, stages of disease progression and regionally across the United States. We aimed to estimate medical costs for PWH and examine the heterogeneity in costs within key patient groups typically distinguished in cost-effectiveness analyses. DESIGN Retrospective cohort study using health administrative databases for diagnosed PWH in care at 17 HIV Research Network sites across the United States. METHODS We estimated mean quarterly costs for key patient groups using multivariable generalized linear mixed effects models. We used quantile regression to highlight differences in the effect of covariates within each patient group (difference between covariate estimates at the mean versus the 90th percentile of quarterly costs), identifying covariates with a larger effect among the highest cost PWH, or generating greater uncertainty in mean cost estimates. RESULTS Our sample included 40 022 patients with a median age of 39 years. Mean quarterly costs were highest for people who inject drugs with advanced disease progression and for PWH on antiretroviral treatment (ART). Within patient groups, we found the most heterogeneity at different levels of resource use for PWH on ART and PWH off ART with CD4 cell counts less than 200 cells/μl, people who inject drugs, as well as PWH in the South. CONCLUSION The study quantifies heterogeneity in costs both across and within key PWH patient groups. Our results highlight the need for sensitivity analysis on cost estimates and may inform decisions on model structure in cost-effectiveness analyses on HIV/AIDS treatment and prevention strategies.
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Griffith DC, Agwu AL. Caring for youth living with HIV across the continuum: turning gaps into opportunities. AIDS Care 2017; 29:1205-1211. [PMID: 28278569 DOI: 10.1080/09540121.2017.1290211] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
With the increasing proportion of youth living with human immunodeficiency virus (YLHIV) and the aging of the perinatally infected population, there is a need for clinical services that are "youth friendly" to address the multiple challenges YLHIV face in terms of engagement in care and maintenance of combination antiretroviral therapy (cART). Little is known about how and where YLHIV receive their care. Further, the impact of the care structure on engagement and retention outcomes for YLHIV is ill defined. In order to better classify how YLHIV receive care in the United States, we performed a review of published literature characterizing the structure and outcomes of care for YLHIV. Several key concepts emerged: 1. The majority of YLHIV (13-24 years old) are cared for at adult sites, 2. Clinics providing care to YLHIV are varied in terms of the services offered and the types of services offered can impact outcomes, 3. YLHIV cared for in adult clinical sites have poor retention and antiretroviral treatment initiation, and 4. YLHIV cared for at adult sites had poorer retention and cART outcomes compared to YLHIV cared for at pediatric sites. There were no studies identified that specifically examined "youth friendly" care for YLHIV within the context of adult clinical sites. The results of this review highlight disparities for YLHIV and the need for interventions to improve outcomes for YLHIV in the context of adult care.
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Affiliation(s)
- David C Griffith
- a Department of Pediatrics , Johns Hopkins School of Medicine , Baltimore , USA.,b Department of Medicine , Johns Hopkins School of Medicine , Baltimore , USA
| | - Allison L Agwu
- a Department of Pediatrics , Johns Hopkins School of Medicine , Baltimore , USA.,b Department of Medicine , Johns Hopkins School of Medicine , Baltimore , USA
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Hadland SE, Yehia BR, Makadon HJ. Caring for Lesbian, Gay, Bisexual, Transgender, and Questioning Youth in Inclusive and Affirmative Environments. Pediatr Clin North Am 2016; 63:955-969. [PMID: 27865338 PMCID: PMC5119916 DOI: 10.1016/j.pcl.2016.07.001] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Lesbian, gay, bisexual, transgender, queer and questioning (LGBTQ) youth may experience interpersonal and structural stigma within the health care environment. This article begins by reviewing special considerations for the care of LGBTQ youth, then turns to systems-level principles underlying inclusive and affirming care. It then examines specific strategies that individual providers can use to provide more patient-centered care, and concludes with a discussion of how clinics and health systems can tailor clinical services to the needs of LGBTQ youth.
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Affiliation(s)
- Scott E Hadland
- Division of Adolescent/Young Adult Medicine, Department of Medicine, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA 02115, USA; Department of Pediatrics, Harvard Medical School, 25 Shattuck Street, Boston, MA 02115, USA.
| | - Baligh R Yehia
- Department of Medicine, Perelman School of Medicine, University of Pennsylvania, 1021 Blockley Hall, 423 Guardian Drive, Philadelphia, PA 19104, USA; Penn Medicine Program for LGBT Health, Perelman School of Medicine, University of Pennsylvania, 1021 Blockley Hall, 423 Guardian Drive, Philadelphia, PA 19104, USA
| | - Harvey J Makadon
- The Fenway Institute, Fenway Health, 1340 Boylston Street, Boston, MA 02215, USA; Department of Medicine, Harvard Medical School, 25 Shattuck Street, Boston, MA 02115, USA
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Lee L, Yehia BR, Gaur AH, Rutstein R, Gebo K, Keruly JC, Moore RD, Nijhawan AE, Agwu AL. The Impact of Youth-Friendly Structures of Care on Retention Among HIV-Infected Youth. AIDS Patient Care STDS 2016; 30:170-7. [PMID: 26983056 DOI: 10.1089/apc.2015.0263] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Limited data exist on how structures of care impact retention among youth living with HIV (YLHIV). We describe the availability of youth-friendly structures of care within HIV Research Network (HIVRN) clinics and examine their association with retention in HIV care. Data from 680 15- to 24-year-old YLHIV receiving care at 7 adult and 5 pediatric clinics in 2011 were included in the analysis. The primary outcome was retention in care, defined as completing ≥2 primary HIV care visits ≥90 days apart in a 12-month period. Sites were surveyed to assess the availability of clinic structures defined a priori as 'youth-friendly'. Univariate and multivariable logistic regression models assessed structures associated with retention in care. Among 680 YLHIV, 85% were retained. Nearly half (48%) of the 680 YLHIV attended clinics with youth-friendly waiting areas, 36% attended clinics with evening hours, 73% attended clinics with adolescent health-trained providers, 87% could email or text message providers, and 73% could schedule a routine appointment within 2 weeks. Adjusting for demographic and clinical factors, YLHIV were more likely to be retained in care at clinics with a youth-friendly waiting area (AOR 2.47, 95% CI [1.11-5.52]), evening clinic hours (AOR 1.94; 95% CI [1.13-3.33]), and providers with adolescent health training (AOR 1.98; 95% CI [1.01-3.86]). Youth-friendly structures of care impact retention in care among YLHIV. Further investigations are needed to determine how to effectively implement youth-friendly strategies across clinical settings where YLHIV receive care.
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Affiliation(s)
- Lana Lee
- Divisions of General Pediatrics and Adolescent Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Baligh R. Yehia
- Department of Infectious Diseases, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Aditya H. Gaur
- Department of Infectious Diseases, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Richard Rutstein
- Division of General Pediatrics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Kelly Gebo
- Divisions of Infectious Diseases, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Jeanne C. Keruly
- Divisions of Infectious Diseases, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Richard D. Moore
- Divisions of Infectious Diseases, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Ank E. Nijhawan
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Allison L. Agwu
- Divisions of Adult and Pediatric Infectious Diseases, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland
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Agwu AL, Lee L, Fleishman JA, Voss C, Yehia BR, Althoff KN, Rutstein R, Mathews WC, Nijhawan A, Moore RD, Gaur AH, Gebo KA. Aging and loss to follow-up among youth living with human immunodeficiency virus in the HIV Research Network. J Adolesc Health 2015; 56:345-51. [PMID: 25703322 PMCID: PMC4378241 DOI: 10.1016/j.jadohealth.2014.11.009] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2014] [Revised: 10/17/2014] [Accepted: 11/14/2014] [Indexed: 10/24/2022]
Abstract
PURPOSE In the United States, 21 years is a critical age of legal and social transition, with changes in social programs such as public insurance coverage. Human immunodeficiency virus (HIV)-infected youth have lower adherence to care and medications and may be at risk of loss to follow-up (LTFU) at this benchmark age. We evaluated LTFU after the 22nd birthday for HIV-infected youth engaged in care. LTFU was defined as having no primary HIV visits in the year after the 22nd birthday. METHODS All HIV-infected 21-year-olds engaged in care (2002-2011) at the HIV Research Network clinics were included. We assessed the proportion LTFU and used multivariable logistic regression to evaluate demographic and clinical characteristics associated with LTFU after the 22nd birthday. We compared LTFU at other age transitions during the adolescent/young adult years. RESULTS Six hundred forty-seven 21-year-olds were engaged in care; 91 (19.8%) were LTFU in the year after turning 22 years. Receiving care at an adult versus pediatric HIV clinic (adjusted odds ratio [AOR], 2.91; 95% confidence interval [CI], 1.42-5.93), having fewer than four primary HIV visits/year (AOR, 2.72; 95% CI, 1.67-4.42), and antiretroviral therapy prescription (AOR, .50; 95% CI, .41-.60) were independently associated with LTFU. LTFU was prevalent at each age transition, with factors associated with LTFU similar to that identified for 21-year-olds. CONCLUSIONS Although 19.8% of 21-year-olds at the HIV Research Network sites were LTFU after their 22nd birthday, significant proportions of youth of all ages were LTFU. Fewer than four primary HIV care visits/year, receiving care at adult clinics and not prescribed antiretroviral therapy, were associated with LTFU and may inform targeted interventions to reduce LTFU for these vulnerable patients.
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Affiliation(s)
- Allison L. Agwu
- Division of Pediatric Infectious Diseases, Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, Maryland,Division of Infectious Diseases, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland,Address correspondence to: Allison L. Agwu, M.D., Sc.M., Division of Pediatric Infectious Diseases, Department of Pediatrics, Johns Hopkins Medical Institutions, 200 N. Wolfe Street, Room 3145, Baltimore, MD 21287. (A.L. Agwu)
| | - Lana Lee
- Division of General Pediatrics and Adolescent Medicine, Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - John A. Fleishman
- Center for Financing, Access, and Cost Trends, Agency for Healthcare Research and Quality, Rockville, Maryland
| | - Cindy Voss
- Division of Infectious Diseases, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Baligh R. Yehia
- Division of Infectious Diseases, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Keri N. Althoff
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Richard Rutstein
- Division of General Pediatrics, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - W. Christopher Mathews
- Department of Clinical Medicine, University of California San Diego Medical Center, San Diego, California
| | - Ank Nijhawan
- Department of Internal Medicine, UT Southwestern Medical Center, Dallas Texas
| | - Richard D. Moore
- Division of General Internal Medicine, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Aditya H. Gaur
- Department of Infectious Diseases, St. Jude Children’s Research Hospital, Memphis, Tennessee
| | - Kelly A. Gebo
- Division of Infectious Diseases, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland
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Schranz AJ, Brady KA, Momplaisir F, Metlay JP, Stephens A, Yehia BR. Comparison of HIV outcomes for patients linked at hospital versus community-based clinics. AIDS Patient Care STDS 2015; 29:117-25. [PMID: 25665013 DOI: 10.1089/apc.2014.0199] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
Outpatient care for people living with HIV is delivered in diverse settings. Differences in setting may impact HIV outcomes. We evaluated HIV-infected adults in care at Ryan White-funded clinics in Philadelphia, PA, between 2008 and 2011 to determine how setting of care (hospital versus community-based) influenced HIV outcomes. Clinics were categorized as hospital-based if they were located onsite at a hospital. The composite outcome was completion of the final three steps of the HIV care continuum: (1) retention in care; (2) use of antiretroviral therapy (ART); and (3) viral suppression. Mixed-effects logistic regression, accounting for patient and clinic factors, examined the relationship between care setting and the outcome. In total, 12,637 patients, contributing 32,515 patient-years, received care at 25 clinics (12 hospital-based). Women, non-Hispanic blacks, those with private insurance, and individuals with higher household incomes more commonly attended hospital-based clinics (p<0.05). Of the 12,962 patient-years (40%) during which patients attended community-based clinics, 59% met the outcome. Similarly, 59% of the 19,553 patient-years (60%) in which patients attended hospital-based clinics met the outcome. Adjusting for patient and clinic factors, setting was not associated with the outcome (adjusted odds ratio=1.24, 95% CI=0.84-1.84). In summary, demographics differ among patients visiting hospital and community-based clinics. Completion of the final three steps of the HIV care continuum did not vary between hospital and community-based clinics, which may reflect advances in HIV therapy and the wide availability of HIV care resources.
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Affiliation(s)
- Asher J. Schranz
- Department of Medicine, New York University School of Medicine, New York, New York
| | - Kathleen A. Brady
- Department of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
- AIDS Activities Coordinating Office, Philadelphia Department of Public Health, Philadelphia, Pennsylvania
| | - Florence Momplaisir
- Department of Medicine, Drexel University School of Medicine, Philadelphia, Pennsylvania
| | - Joshua P. Metlay
- Division of General Internal Medicine, Massachusetts General Hospital, Boston, Massachusetts
| | - Alisa Stephens
- Center for Biostatistics and Epidemiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Baligh R. Yehia
- Department of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
- Center for Biostatistics and Epidemiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania
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8
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Abstract
We examined trends in health insurance coverage among 36,999 HIV-infected adults in care at 11 US HIV clinics between 2006 and 2012. Aggregate health insurance coverage was stable during this time. The proportions of patient-years with private, Medicaid, Medicare, and no insurance during this period were 15.9%, 35.7%, 20.1%, and 28.4%, respectively. Medicaid coverage was more prevalent among women than men, blacks, and Hispanics than whites, and individuals with injection drug use risk compared with other transmission risk factors. Hispanics and younger age groups were more likely to be uninsured than other racial/ethnic and older age groups, respectively.
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Yehia BR, Herati RS, Fleishman JA, Gallant JE, Agwu AL, Berry SA, Korthuis PT, Moore RD, Metlay JP, Gebo KA. Hepatitis C virus testing in adults living with HIV: a need for improved screening efforts. PLoS One 2014; 9:e102766. [PMID: 25032989 PMCID: PMC4102540 DOI: 10.1371/journal.pone.0102766] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2014] [Accepted: 06/21/2014] [Indexed: 01/08/2023] Open
Abstract
OBJECTIVES Guidelines recommend hepatitis C virus (HCV) screening for all people living with HIV (PLWH). Understanding HCV testing practices may improve compliance with guidelines and can help identify areas for future intervention. METHODS We evaluated HCV screening and unnecessary repeat HCV testing in 8,590 PLWH initiating care at 12 U.S. HIV clinics between 2006 and 2010, with follow-up through 2011. Multivariable logistic regression examined the association between patient factors and the outcomes: HCV screening (≥1 HCV antibody tests during the study period) and unnecessary repeat HCV testing (≥1 HCV antibody tests in patients with a prior positive test result). RESULTS Overall, 82% of patients were screened for HCV, 18% of those screened were HCV antibody-positive, and 40% of HCV antibody-positive patients had unnecessary repeat HCV testing. The likelihood of being screened for HCV increased as the number of outpatient visits rose (adjusted odds ratio 1.02, 95% confidence interval 1.01-1.03). Compared to men who have sex with men (MSM), patients with injection drug use (IDU) were less likely to be screened for HCV (0.63, 0.52-0.78); while individuals with Medicaid were more likely to be screened than those with private insurance (1.30, 1.04-1.62). Patients with heterosexual (1.78, 1.20-2.65) and IDU (1.58, 1.06-2.34) risk compared to MSM, and those with higher numbers of outpatient (1.03, 1.01-1.04) and inpatient (1.09, 1.01-1.19) visits were at greatest risk of unnecessary HCV testing. CONCLUSIONS Additional efforts to improve compliance with HCV testing guidelines are needed. Leveraging health information technology may increase HCV screening and reduce unnecessary testing.
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Affiliation(s)
- Baligh R Yehia
- Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, United States of America; Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania, United States of America
| | - Ramin S Herati
- Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, United States of America
| | - John A Fleishman
- Center for Financing, Access, and Cost Trends, Agency for Healthcare Research and Quality, Rockville, Maryland, United States of America
| | - Joel E Gallant
- Southwest Care Center, Santa Fe, New Mexico, United States of America
| | - Allison L Agwu
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States of America
| | - Stephen A Berry
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States of America
| | - P Todd Korthuis
- Department of Medicine, Oregon Health and Sciences University, Portland, Oregon, United States of America
| | - Richard D Moore
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States of America
| | - Joshua P Metlay
- General Medicine Division, Massachusetts General Hospital, Boston, Massachusetts, United States of America
| | - Kelly A Gebo
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States of America
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Retention in care is more strongly associated with viral suppression in HIV-infected patients with lower versus higher CD4 counts. J Acquir Immune Defic Syndr 2014; 65:333-9. [PMID: 24129370 DOI: 10.1097/qai.0000000000000023] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Retention in care is important for all HIV-infected patients, but may be more important for people with advanced HIV disease. We evaluated whether the association between retention in care and viral suppression differed by HIV disease severity. METHODS A repeated cross-sectional analysis (2006-2011) involving 35,433 adults at 18 US HIV clinics. Multivariable logistic regression models examined associations between retention measures [Health Resources and Services Administration (HRSA) retention measure, 6-month gap, and 3-month visit constancy] and viral suppression (HIV-1 RNA ≤ 400 copies/mL) for HIV disease severity groups defined by CD4 counts: ≤ 200, 201-350, 351-500, and >500 cells per cubic millimeter. RESULTS Overall, patients met the HRSA measure in 84% of person-years, did not have a 6-month gap in 76%, and had visits in all 4 quarters in 37%; patients achieved viral suppression in 72% of person-years. The association between retention in care and viral suppression differed by disease severity, and was strongest for patients with lower CD4 counts: ≤ 200 [adjusted odds ratio (AOR) = 2.33, 95% confidence interval (CI): 2.16 to 2.51], 201-350 (AOR = 1.96, CI: 1.81 to 2.12), 351-500 (AOR = 1.65, CI: 1.53 to 1.78), and >500 cells per cubic millimeter (AOR = 1.22, CI: 1.14 to 1.30) using the HRSA retention measure as a representative example. CONCLUSIONS This is one of the first studies to report the impact of HIV disease severity on retention in care and viral suppression, demonstrating that retention in care is more strongly associated with viral suppression in patients with lower CD4 counts. These results have important implications for improving the health of patients with advanced HIV disease and for test and treat approaches to HIV prevention.
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11
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Keller SC, Yehia BR, Momplaisir FO, Eberhart MG, Share A, Brady KA. Assessing the overall quality of health care in persons living with HIV in an urban environment. AIDS Patient Care STDS 2014; 28:198-205. [PMID: 24654969 DOI: 10.1089/apc.2014.0001] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
Ensuring high quality primary care for people living with HIV (PLWH) is important. We studied factors associated with meeting Health Resources and Services Administration-identified HIV performance measures, among a population-based sample of 376 PLWH in care at 24 Philadelphia clinics. Quality of care was assessed by a patient-level composite of 15 performance measures, focusing on HIV-specific care, vaccinations, and co-morbid condition screening. Adjusted incidence rate ratios (IRR) demonstrated relationships between patient and clinic factors and the performance measures score. The mean number of measures met was 8.52. Older age groups met more measures than 18- to 29-year-olds (age 40-49: adjusted IRR: 1.19, 95% CI: 1.05-1.35; age ≥50: adjusted IRR: 1.19, 95% CI: 1.03-1.35). Higher CD4 counts were associated with meeting more measures compared to CD4 <200 cells/μL (CD4 350-499 cells/μL: adjusted IRR: 1.14, 95% CI: 1.02-1.28; ≥500 cells/μL: adjusted IRR: 1.12, 95% CI: 1.01-1.26). PLWH attending clinics that provide adherence counseling or case management met more measures (adjusted IRR: 1.12, 95% CI: 1.04-1.21; adjusted IRR: 1.08, 95% CI: 1.02-1.14; respectively) than those attending clinics without these services. Limitations include potentially poor performance measure documentation and equal treatment of measures. Future work should focus on improving compliance with performance measures.
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Affiliation(s)
- Sara C. Keller
- Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Baligh R. Yehia
- Division of Infectious Diseases, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Florence O. Momplaisir
- Division of Infectious Diseases, Temple University School of Medicine, Philadelphia, Pennsylvania
| | - Michael G. Eberhart
- AIDS Activities Coordinating Office, City of Philadelphia Department of Public Health, Philadelphia, Pennsylvania
| | - Amanda Share
- AIDS Activities Coordinating Office, City of Philadelphia Department of Public Health, Philadelphia, Pennsylvania
| | - Kathleen A. Brady
- Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, Maryland
- AIDS Activities Coordinating Office, City of Philadelphia Department of Public Health, Philadelphia, Pennsylvania
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DiClemente RJ, Jackson JM. Towards an integrated framework for accelerating the end for the global HIV epidemic among young people. SEX EDUCATION 2014; 14:609-621. [PMID: 25197260 PMCID: PMC4153437 DOI: 10.1080/14681811.2014.901214] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
For decades the HIV epidemic has exacted an enormous toll worldwide. However, trend analyses have discerned significant declines in the overall prevalence of HIV over the last two decades. More recently, advances in biomedical, behavioural, and structural interventions offer considerable promise in the battle against generalised epidemics. Despite advances in the prevention of transmission and new infections, morbidity and mortality of HIV among young people remains a considerable concern for individuals, couples, families, communities, practitioners, and policy makers around the globe. To accelerate the end of the global HIV epidemic among young people, we must merge existing efficacious interventions with more novel, cost-effective implementation strategies to develop integrated, multilevel combination interventions. The benefits of conceptualising the HIV epidemic more broadly and adopting ecological frameworks for the development of HIV prevention programmes are critical.
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Affiliation(s)
- Ralph J. DiClemente
- Department of Behavioral Sciences & Health Education, Center for AIDS Research, Prevention Sciences & Epidemiology Core, Rollins School of Public Health, Emory University, Atlanta, GA, USA
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