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Hernandez M, Guarino H, Kozlowski S, Srivastava A, Schenkel R, Tapia T, Seabrook TB, Nash D, Irvine MK. Addressing Mental Health Barriers in HIV Care Coordination Is Crucial to Providing Optimal HIV/AIDS Care. AIDS Patient Care STDS 2024; 38:107-114. [PMID: 38471091 DOI: 10.1089/apc.2023.0240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/14/2024] Open
Abstract
For people with HIV (PWH) who have psychological comorbidities, effective management of mental health issues is crucial to achieving and maintaining viral suppression. Care coordination programs (CCPs) have been shown to improve outcomes across the HIV care continuum, but little research has focused on the role of care coordination in supporting the mental health of PWH. This study reports qualitative findings from the Program Refinements to Optimize Model Impact and Scalability based on Evidence (PROMISE) study, which evaluated a revised version of an HIV CCP for Ryan White Part A clients in New York City. Semistructured interviews were conducted with 30 providers and 27 clients from 6 CCP-implementing agencies to elucidate barriers and facilitators of program engagement. Transcripts were analyzed for key themes related to clients' mental health needs and providers' successes and challenges in meeting these needs. Providers and clients agreed that insufficiently managed mental health issues are a common barrier to achieving and maintaining viral suppression. Although the CCP model calls for providers to address clients' unmet mental health needs primarily through screening and referrals to psychiatric and/or psychological care, both clients and providers reported that the routine provision of emotional support is a major part of providers' role that is highly valued by clients. Some concerns raised by providers included insufficient training to address clients' mental health needs and an inability to document the provision of emotional support as a delivered service. These findings suggest the potential value of formally integrating mental health services into HIV care coordination provision. ClinicalTrials.gov protocol number: NCT03628287.
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Affiliation(s)
- Miguel Hernandez
- Institute for Implementation Science in Population Health (ISPH), CUNY Graduate School of Public Health & Health Policy, New York, New York, USA
| | - Honoria Guarino
- Institute for Implementation Science in Population Health (ISPH), CUNY Graduate School of Public Health & Health Policy, New York, New York, USA
| | - Sarah Kozlowski
- Institute for Implementation Science in Population Health (ISPH), CUNY Graduate School of Public Health & Health Policy, New York, New York, USA
| | - Avantika Srivastava
- Institute for Implementation Science in Population Health (ISPH), CUNY Graduate School of Public Health & Health Policy, New York, New York, USA
| | - Rachel Schenkel
- Institute for Implementation Science in Population Health (ISPH), CUNY Graduate School of Public Health & Health Policy, New York, New York, USA
| | - Thamara Tapia
- Institute for Implementation Science in Population Health (ISPH), CUNY Graduate School of Public Health & Health Policy, New York, New York, USA
| | - Tyeirra B Seabrook
- Institute for Implementation Science in Population Health (ISPH), CUNY Graduate School of Public Health & Health Policy, New York, New York, USA
| | - Denis Nash
- Institute for Implementation Science in Population Health (ISPH), CUNY Graduate School of Public Health & Health Policy, New York, New York, USA
| | - Mary K Irvine
- Institute for Implementation Science in Population Health (ISPH), CUNY Graduate School of Public Health & Health Policy, New York, New York, USA
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Irvine MK, Abdelqader F, Levin B, Thomas J, Avoundjian T, Peterson M, Zimba R, Braunstein SL, Robertson MM, Nash D. Study protocol for data to suppression (D2S): a cluster-randomised, stepped-wedge effectiveness trial of a reporting and capacity-building intervention to improve HIV viral suppression in housing and behavioural health programmes in New York City. BMJ Open 2023; 13:e076716. [PMID: 37451738 PMCID: PMC10351323 DOI: 10.1136/bmjopen-2023-076716] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/18/2023] Open
Abstract
INTRODUCTION With progress in the 'diagnose', 'link' and 'retain' stages of the HIV care continuum, viral suppression (VS) gains increasingly hinge on antiretroviral adherence among people with HIV (PWH) retained in care. The Centers for Disease Control and Prevention estimate that unsuppressed viral load among PWH in care accounts for 20% of onward transmission. HIV intervention strategies include 'data to care' (D2C)-using surveillance to identify out-of-care PWH for follow-up. However, most D2C efforts target care linkage, not antiretroviral adherence, and limit client-level data sharing to medical (versus support-service) providers. Drawing on lessons learnt in D2C and successful local pilots, we designed a 'data-to-suppression' intervention that offers HIV support-service programmes surveillance-based reports listing their virally unsuppressed clients and capacity-building assistance for quality-improvement activities. We aimed to scale and test the intervention in agencies delivering Ryan White HIV/AIDS Programme-funded behavioural health and housing services. METHODS AND ANALYSIS To estimate intervention effects, this study applies a cross-sectional, stepped-wedge design to the intervention's rollout to 27 agencies randomised within matched pairs to early or delayed implementation. Data from three 12-month periods (pre-implementation, partial implementation and full implementation) will be examined to assess intervention effects on timely VS (within 6 months of a report listing the client as needing follow-up for VS). Based on projected enrolment (n=1619) and a pre-implementation outcome probability of 0.40-0.45, the detectable effect size with 80% power is an OR of 2.12 (relative risk: 1.41-1.46). ETHICS AND DISSEMINATION This study was approved by the New York City Department of Health and Mental Hygiene's institutional review board (protocol: 21-036) with a waiver of informed consent. Findings will be disseminated via publications, conferences and meetings including provider-agency representatives. TRIAL REGISTRATION NUMBER NCT05140421.
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Affiliation(s)
- Mary K Irvine
- Bureau of Hepatitis, HIV, and Sexually Transmitted Infections, New York City Department of Health and Mental Hygiene, New York City, New York, USA
| | - Faisal Abdelqader
- Bureau of Hepatitis, HIV, and Sexually Transmitted Infections, New York City Department of Health and Mental Hygiene, New York City, New York, USA
| | - Bruce Levin
- Department of Biostatistics, Mailman School of Public Health, Columbia University, New York City, New York, USA
| | - Jacinthe Thomas
- Bureau of Hepatitis, HIV, and Sexually Transmitted Infections, New York City Department of Health and Mental Hygiene, New York City, New York, USA
| | - Tigran Avoundjian
- Bureau of Hepatitis, HIV, and Sexually Transmitted Infections, New York City Department of Health and Mental Hygiene, New York City, New York, USA
| | - Meghan Peterson
- Bureau of Hepatitis, HIV, and Sexually Transmitted Infections, New York City Department of Health and Mental Hygiene, New York City, New York, USA
| | - Rebecca Zimba
- Institute for Implementation Science in Population Health, City University of New York, New York City, New York, USA
| | - Sarah L Braunstein
- Bureau of Hepatitis, HIV, and Sexually Transmitted Infections, New York City Department of Health and Mental Hygiene, New York City, New York, USA
| | - McKaylee M Robertson
- Institute for Implementation Science in Population Health, City University of New York, New York City, New York, USA
| | - Denis Nash
- Institute for Implementation Science in Population Health, City University of New York, New York City, New York, USA
- Department of Epidemiology and Biostatistics, City University of New York, New York City, New York, USA
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Irvine MK, Levin B, Abdelqader F, Carmona J, Avoundjian T, Thomas J, Braunstein SL, Robertson M, Nash D. Evaluation of the Revised Versus Original Ryan White Part A HIV Care Coordination Program in a Cluster-Randomized, Stepped-Wedge Trial. J Acquir Immune Defic Syndr 2023; 92:325-333. [PMID: 36729538 PMCID: PMC9936966 DOI: 10.1097/qai.0000000000003139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND To address challenges with delivery of an evidence-based HIV care coordination program (CCP), the New York City Health Department initiated a CCP redesign. We conducted a site-randomized stepped-wedge trial to evaluate effectiveness of the revised versus the original model. SETTING The CCP is delivered in New York City hospitals, community health centers, and community-based organizations to people experiencing or at risk for poor HIV outcomes. METHODS The outcome, timely viral suppression (TVS), was defined as achievement of viral load <200 copies/mL within 4 months among enrollees with unsuppressed viral load (≥200 copies/mL). Seventeen original-CCP provider agencies were randomized within matched pairs to early (August 2018) or delayed (May 2019) starts of revised-model implementation. Data from 3 periods were examined to compare revised versus original CCP effects on TVS. The primary analysis of the intervention effect applied fully conditional maximum likelihood estimation together with an exact, conditional P -value and an exact test-based 95% CI. We assigned each trial enrollee the implementation level of their site (based on a three-component measure) and tested for association with TVS, adjusting for period and study arm. RESULTS Over 3 nine-month periods, 960 individuals were eligible for trial inclusion (intention to treat). The odds ratio of TVS versus no TVS comparing revised with original CCP was 0.88 (95% CI: 0.45, 1.7). Thus, the revised program yielded slightly lower TVS, although the effect was statistically nonsignificant. TVS was not significantly associated with revised-CCP implementation level. CONCLUSION Program revisions did not increase TVS, irrespective of the implementation level.
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Affiliation(s)
- Mary K. Irvine
- Bureau of Hepatitis, HIV and Sexually Transmitted Infections (BHHS), New York City Department of Health and Mental Hygiene (DOHMH); New York, NY
| | - Bruce Levin
- Department of Biostatistics, Mailman School of Public Health (MSPH), Columbia University (CU); New York, NY; and
| | - Faisal Abdelqader
- Bureau of Hepatitis, HIV and Sexually Transmitted Infections (BHHS), New York City Department of Health and Mental Hygiene (DOHMH); New York, NY
| | - Jennifer Carmona
- Bureau of Hepatitis, HIV and Sexually Transmitted Infections (BHHS), New York City Department of Health and Mental Hygiene (DOHMH); New York, NY
| | - Tigran Avoundjian
- Bureau of Hepatitis, HIV and Sexually Transmitted Infections (BHHS), New York City Department of Health and Mental Hygiene (DOHMH); New York, NY
| | - Jacinthe Thomas
- Bureau of Hepatitis, HIV and Sexually Transmitted Infections (BHHS), New York City Department of Health and Mental Hygiene (DOHMH); New York, NY
| | - Sarah L. Braunstein
- Bureau of Hepatitis, HIV and Sexually Transmitted Infections (BHHS), New York City Department of Health and Mental Hygiene (DOHMH); New York, NY
| | - McKaylee Robertson
- Institute for Implementation Science in Population Health (ISPH), Graduate School of Public Health and Health Policy, City University of New York (CUNY); New York, NY
| | - Denis Nash
- Institute for Implementation Science in Population Health (ISPH), Graduate School of Public Health and Health Policy, City University of New York (CUNY); New York, NY
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Robertson MM, Irvine MK, Penrose K, Harriman G, Braunstein SL, Nash D. Mortality among clients in the New York city HIV Care Coordination Program (CCP): incidence and associated clinical factors. Ann Epidemiol 2021; 64:161-166. [PMID: 34634472 DOI: 10.1016/j.annepidem.2021.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Revised: 09/30/2021] [Accepted: 10/03/2021] [Indexed: 11/27/2022]
Abstract
PURPOSE We examined psychosocial factors (housing, drug use, incarceration history or mental health) and care factors (comorbidities and acute care) associated with all-cause and HIV-related mortality while enrolled in the New York City Ryan White HIV Care Coordination Program (CCP), an intensive case management program for people with barriers to HIV care and treatment. METHODS We used hazards regression (HR) to understand factors associated with mortality. RESULTS 8,135 people (13,479.4 person years [PY]) enrolled in the CCP from March 2011 to December 2016. The all-cause mortality rate while enrolled was 28.8 per 1000 PY (N = 388), with 43% of deaths (N = 167) related to HIV (12.4 per 1000 PY). Controlling for demographics and clinical status, the variables associated with increased hazards of all-cause mortality included hospitalizations or emergency-department visits prior to enrollment (aHRHospitalizations: 2.54; 95% Confidence Interval 2.07-3.11 and aHRED: 1.54; 1.24-1.92) or a diabetes or Hepatitis C diagnosis at enrollment (aHRDiabetes: 1.80; 1.36-2.37 and aHRHCV: 1.78; 1.37-2.30). These factors also increased the hazards of HIV-related mortality. CONCLUSIONS CCP and similar case management programs should systematically screen enrolling clients for a history of acute care and comorbidities, as they may be important markers of need for more intensive engagement and follow-up to prevent death.
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Affiliation(s)
- McKaylee M Robertson
- Institute for Implementation Science in Population Health (ISPH), City University of New York (CUNY), New York City, NY; Graduate School of Public Health and Health Policy, City University of New York (CUNY), New York City, NY.
| | - Mary K Irvine
- New York City Department of Health and Mental Hygiene, New York City, NY
| | - Katherine Penrose
- New York City Department of Health and Mental Hygiene, New York City, NY
| | - Graham Harriman
- New York City Department of Health and Mental Hygiene, New York City, NY
| | - Sarah L Braunstein
- New York City Department of Health and Mental Hygiene, New York City, NY
| | - Denis Nash
- Institute for Implementation Science in Population Health (ISPH), City University of New York (CUNY), New York City, NY; Graduate School of Public Health and Health Policy, City University of New York (CUNY), New York City, NY
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Thomas JA, Irvine MK, Xia Q, Harriman GA. Service utilization and HIV outcomes among transgender women receiving Ryan White Part A services in New York City. PLoS One 2021; 16:e0253444. [PMID: 34197479 PMCID: PMC8248705 DOI: 10.1371/journal.pone.0253444] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Accepted: 06/06/2021] [Indexed: 11/26/2022] Open
Abstract
Background Prior research has found evidence of gender disparities in U.S. HIV healthcare access and outcomes. In order to assess potential disparities in our client population, we compared demographics, service needs, service utilization, and HIV care continuum outcomes between transgender women, cisgender women, and cisgender men receiving New York City (NYC) Ryan White Part A (RWPA) services. Methods The analysis included HIV-positive clients with an intake assessment between January 2016 and December 2017 in an NYC RWPA services program. We examined four service need areas: food and nutrition, harm reduction, mental health, and housing. Among clients with the documented need, we ascertained whether they received RWPA services targeting that need. To compare HIV outcomes between groups, we applied five metrics: engagement in care, consistent engagement in care, antiretroviral therapy (ART) use, point-in-time viral suppression, and durable viral suppression. Results All four service needs were more prevalent among transgender women (N = 455) than among cisgender clients. Except in the area of food and nutrition services, timely (12-month) receipt of RWPA services to meet a specific assessed need was not significantly more or less common in any one of the three client groups examined. Compared to cisgender women and cisgender men, a lower proportion of transgender women were durably virally suppressed (39% versus 52% or 50%, respectively, p-value < 0.001). Conclusions Compared with cisgender women and cisgender men, transgender women more often presented with basic (food/housing) and behavioral-health service needs. In all three groups (with no consistent between-group differences), assessed needs were not typically met with the directly corresponding RWPA service category. Targeting those needs with RWPA outreach and services may support the National HIV/AIDS Strategy 2020 goal of reducing health disparities, and specifically the objective of increasing (to ≥90%) the percentage of transgender women in HIV medical care who are virally suppressed.
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Affiliation(s)
- Jacinthe A. Thomas
- New York City Department of Health and Mental Hygiene, Queens, New York, United States of America
- * E-mail:
| | - Mary K. Irvine
- New York City Department of Health and Mental Hygiene, Queens, New York, United States of America
| | - Qiang Xia
- New York City Department of Health and Mental Hygiene, Queens, New York, United States of America
| | - Graham A. Harriman
- New York City Department of Health and Mental Hygiene, Queens, New York, United States of America
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O'Donnell L, Irvine MK, Wilkes AL, Rwan J, Myint-U A, Leow DM, Whittier D, Harriman G, Bessler P, Higa D, Courtenay-Quirk C. STEPS to Care: Translating an Evidence-Informed HIV Care Coordination Program Into a Field-Tested Online Practice Improvement Toolkit. AIDS Educ Prev 2020; 32:296-310. [PMID: 32897131 DOI: 10.1521/aeap.2020.32.4.296] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Increasing care engagement is essential to meet HIV prevention goals and achieve viral suppression. It is difficult, however, for agencies to establish the systems and practice improvements required to ensure coordinated care, especially for clients with complex health needs. We describe the theory-driven, field-informed transfer process used to translate key components of the evidence-informed Ryan White Part A New York City Care Coordination Program into an online practice improvement toolkit, STEPS to Care (StC), with the potential to support broader dissemination. Informed by analyses of qualitative and quantitative data collected from eight agencies, we describe our four phases: (1) review of StC strategies and key elements, (2) translation into a three-part toolkit: Care Team Coordination, Patient Navigation, and HIV Self-Management, (3) pilot testing, and (4) toolkit refinement for national dissemination. Lessons learned can guide the translation of evidence-informed strategies to online environments, a needed step to achieve wide-scale implemention.
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Affiliation(s)
| | - Mary K Irvine
- Bureau of HIV Prevention and Control, New York City Department of Health and Mental Hygiene, Queens, New York
| | - Aisha L Wilkes
- Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Julie Rwan
- Bureau of HIV Prevention and Control, New York City Department of Health and Mental Hygiene, Queens, New York
| | - Athi Myint-U
- Education Development Center, Inc., Waltham, Massachusetts
| | | | - David Whittier
- Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Graham Harriman
- Bureau of HIV Prevention and Control, New York City Department of Health and Mental Hygiene, Queens, New York
| | - Patricia Bessler
- Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Darrel Higa
- Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Cari Courtenay-Quirk
- Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia
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Irvine MK, Levin B, Robertson MM, Penrose K, Carmona J, Harriman G, Braunstein SL, Nash D. PROMISE (Program Refinements to Optimize Model Impact and Scalability based on Evidence): a cluster-randomised, stepped-wedge trial assessing effectiveness of the revised versus original Ryan White Part A HIV Care Coordination Programme for patients with barriers to treatment in the USA. BMJ Open 2020; 10:e034624. [PMID: 32718922 PMCID: PMC7389516 DOI: 10.1136/bmjopen-2019-034624] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
INTRODUCTION Growing evidence supports combining social, behavioural and biomedical strategies to strengthen the HIV care continuum. However, combination interventions can be resource-intensive and challenging to scale up. Research is needed to identify intervention components and delivery models that maximise uptake, engagement and effectiveness. In New York City (NYC), a multicomponent Ryan White Part A-funded medical case management intervention called the Care Coordination Programme (CCP) was launched at 28 agencies in 2009 in order to address barriers to care and treatment. Effectiveness estimates based on >7000 clients enrolled by April 2013 and their controls indicated modest CCP benefits over 'usual care' for short-term and long-term viral suppression, with substantial room for improvement. METHODS AND ANALYSIS Integrating evaluation findings and CCP service-provider and community-stakeholder input on modifications, the NYC Health Department packaged a Care Coordination Redesign (CCR) in a 2017 request for proposals. Following competitive re-solicitation, 17 of the original CCP-implementing agencies secured contracts. These agencies were randomised within matched pairs to immediate or delayed CCR implementation. Data from three 9-month periods (pre-implementation, partial implementation and full implementation) will be examined to compare CCR versus CCP effects on timely viral suppression (TVS, within 4 months of enrolment) among individuals with unsuppressed HIV viral load newly enrolling in the CCR/CCP. Based on current enrolment (n=933) and the pre-implementation outcome probability (TVS=0.54), the detectable effect size with 80% power is an OR of 2.75 (relative risk: 1.41). ETHICS AND DISSEMINATION This study was approved by the NYC Department of Health and Mental Hygiene Institutional Review Board (IRB, Protocol 18-009) and the City University of New York Integrated IRB (Protocol 018-0057) with a waiver of informed consent. Findings will be disseminated via publications, conferences, stakeholder meetings, and Advisory Board meetings with implementing agency representatives. TRIAL REGISTRATION NUMBER Registered with ClinicalTrials.gov under identifier: NCT03628287, V.2, 25 September 2019; pre-results.
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Affiliation(s)
- Mary K Irvine
- Bureau of HIV, New York City Department of Health and Mental Hygiene, Queens, New York, USA
| | - Bruce Levin
- Department of Biostatistics, Mailman School of Public Health (MSPH), Columbia University, New York, New York, USA
| | - McKaylee M Robertson
- Institute for Implementation Science in Population Health, Graduate School of Public Health and Health Policy, City University of New York, New York, New York, USA
| | - Katherine Penrose
- Bureau of HIV, New York City Department of Health and Mental Hygiene, Queens, New York, USA
| | - Jennifer Carmona
- Bureau of HIV, New York City Department of Health and Mental Hygiene, Queens, New York, USA
| | - Graham Harriman
- Bureau of HIV, New York City Department of Health and Mental Hygiene, Queens, New York, USA
| | - Sarah L Braunstein
- Bureau of HIV, New York City Department of Health and Mental Hygiene, Queens, New York, USA
| | - Denis Nash
- Institute for Implementation Science in Population Health, Graduate School of Public Health and Health Policy, City University of New York, New York, New York, USA
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Robertson MM, Penrose K, Nash D, Harriman G, Braunstein SL, Levin B, Irvine MK. Impact of an HIV Care Coordination Program on the Timeliness of Viral Suppression and Immune Recovery Among Clients Newly Diagnosed with HIV. AIDS Behav 2020; 24:1237-1242. [PMID: 31728695 DOI: 10.1007/s10461-019-02732-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
We compared the time to immune recovery and viral suppression (VS) among people newly diagnosed with HIV who enrolled in the HIV Care Coordination Program (CCP), a comprehensive medical case management program, with a propensity matched group of newly diagnosed people who did not enroll. CCP enrollees had more rapid VS (≤ 200 copies/mL) [hazards ratio (HR) 1.17; 95% confidence interval 1.02-1.34] but no more rapid immune recovery (≥ two successive CD4 counts > 500 cells/mm3) (HR 0.98; 0.84-1.13). Relative to usual care, the CCP may expedite VS (though not immune recovery) for newly diagnosed HIV patients and therefore lower forward transmission risk.
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Affiliation(s)
- McKaylee M Robertson
- Institute for Implementation Science in Population Health (ISPH), City University of New York (CUNY), 55 W. 125th St, New York City, NY, 10027, USA.
- Graduate School of Public Health and Health Policy, City University of New York (CUNY), New York City, NY, USA.
| | - Kate Penrose
- Bureau of HIV/AIDS Prevention and Control, New York City Department of Health and Mental Hygiene, New York City, NY, USA
| | - Denis Nash
- Institute for Implementation Science in Population Health (ISPH), City University of New York (CUNY), 55 W. 125th St, New York City, NY, 10027, USA
- Graduate School of Public Health and Health Policy, City University of New York (CUNY), New York City, NY, USA
| | - Graham Harriman
- Bureau of HIV/AIDS Prevention and Control, New York City Department of Health and Mental Hygiene, New York City, NY, USA
| | - Sarah L Braunstein
- Bureau of HIV/AIDS Prevention and Control, New York City Department of Health and Mental Hygiene, New York City, NY, USA
| | - Bruce Levin
- Department of Biostatistics, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Mary K Irvine
- Bureau of HIV/AIDS Prevention and Control, New York City Department of Health and Mental Hygiene, New York City, NY, USA
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Stevens ER, Nucifora KA, Irvine MK, Penrose K, Robertson M, Kulkarni S, Robbins R, Abraham B, Nash D, Braithwaite RS. Cost-effectiveness of HIV care coordination scale-up among persons at high risk for sub-optimal HIV care outcomes. PLoS One 2019; 14:e0215965. [PMID: 31022280 PMCID: PMC6483203 DOI: 10.1371/journal.pone.0215965] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2018] [Accepted: 04/12/2019] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND A study of a comprehensive HIV Care Coordination Program (CCP) showed effectiveness in increasing viral load suppression (VLS) among PLWH in New York City (NYC). We evaluated the cost-effectiveness of a scale-up of the CCP in NYC. METHODS We incorporated observed effects and costs of the CCP into a computer simulation of HIV in NYC, comparing strategy scale-up with no implementation. The simulation combined a deterministic compartmental model of HIV transmission with a stochastic microsimulation of HIV progression, and was calibrated to NYC HIV epidemiological data from 1997 to 2009. We assessed incremental cost-effectiveness from a health sector perspective using 2017 $US, a 20-year time horizon, and a 3% annual discount rate. We explored two scenarios: (1) two-year average enrollment and (2) continuous enrollment. RESULTS In scenario 1, scale-up resulted in a cost-per-infection-averted of $898,104 and a cost-per-QALY-gained of $423,721. In sensitivity analyses, scale-up achieved cost-effectiveness if effectiveness increased from RR1.11 to RR1.37 or costs decreased by 41.7%. Limiting the intervention to persons with unsuppressed viral load prior to enrollment (RR1.32) attenuated the cost reduction necessary to 11.5%. In scenario 2, scale-up resulted in a cost-per-infection-averted of $705,171 and cost-per-QALY-gained of $720,970. In sensitivity analyses, scale-up achieved cost-effectiveness if effectiveness increased from RR1.11 to RR1.46 or program costs decreased by 71.3%. Limiting the intervention to persons with unsuppressed viral load attenuated the cost reduction necessary to 38.7%. CONCLUSION Cost-effective CCP scale-up would require reduced costs and/or focused enrollment within NYC, but may be more readily achieved in cities with lower background VLS levels.
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Affiliation(s)
- Elizabeth R. Stevens
- Department of Population Health, NYU School of Medicine, New York, NY, United States of America
- * E-mail:
| | - Kimberly A. Nucifora
- Department of Population Health, NYU School of Medicine, New York, NY, United States of America
| | - Mary K. Irvine
- Bureau of HIV/AIDS Prevention & Control, New York City Department of Health and Mental Hygiene, New York, NY, United States of America
| | - Katherine Penrose
- Bureau of HIV/AIDS Prevention & Control, New York City Department of Health and Mental Hygiene, New York, NY, United States of America
| | - McKaylee Robertson
- Institute for Implementation Science in Population Health, City University of New York, New York, NY, United States of America
- Department of Epidemiology and Biostatistics, School of Public Health, City University of New York, New York, NY, United States of America
| | - Sarah Kulkarni
- Institute for Implementation Science in Population Health, City University of New York, New York, NY, United States of America
| | - Rebekkah Robbins
- Bureau of HIV/AIDS Prevention & Control, New York City Department of Health and Mental Hygiene, New York, NY, United States of America
| | - Bisrat Abraham
- Bureau of HIV/AIDS Prevention & Control, New York City Department of Health and Mental Hygiene, New York, NY, United States of America
| | - Denis Nash
- Institute for Implementation Science in Population Health, City University of New York, New York, NY, United States of America
- Department of Epidemiology and Biostatistics, School of Public Health, City University of New York, New York, NY, United States of America
| | - R. Scott Braithwaite
- Department of Population Health, NYU School of Medicine, New York, NY, United States of America
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Feldman MB, Kepler KL, Irvine MK, Thomas JA. Associations between drug use patterns and viral load suppression among HIV-positive individuals who use support services in New York City. Drug Alcohol Depend 2019; 197:15-21. [PMID: 30743195 DOI: 10.1016/j.drugalcdep.2018.12.015] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2018] [Revised: 11/24/2018] [Accepted: 12/06/2018] [Indexed: 11/19/2022]
Abstract
BACKGROUND Drug use (DU) represents a significant barrier to maintaining physical health among people living with HIV (PLWH). Few studies, however, have examined the relationship between DU over time and HIV treatment outcomes. Such studies are needed because an individual's risk of poor health outcomes may vary with their DU behaviors. We examined associations between DU patterns over time and unsuppressed viral load (VL). METHODS The sample included 7896 PLWH in New York City who completed ≥3 substance use assessments over a 24-month period. DU was defined as crystal methamphetamine, crack/cocaine, heroin, and/or recreational prescription medication use in the last three months. Four behavior patterns were constructed: (1) persistent use (DU reported on each assessment); (2) intermittent use-active (DU reported on the third, but not all previous assessments); (3) intermittent use-inactive (DU reported previously with no DU reported on the third assessment); (4) persistent non-use (no DU reported on any assessment). Unsuppressed VL (>200 copies/mL) was assessed based on the last VL value in the New York City HIV Surveillance Registry in the 12 months following an individual's third DU assessment. RESULTS Compared with persistent non-users, individuals with intermittent use-inactive (aOR = 1.24, 95% CI = 1.03-1.49), intermittent use-active (aOR = 1.68, 95% CI = 1.36-2.06), and persistent use (aOR = 2.21, 95% CI = 1.69-2.89) were significantly more likely to have unsuppressed VL. CONCLUSIONS While providers may be more likely to intervene with persistent or active drug users, our findings suggest the importance of addressing the risk of poor HIV treatment outcomes among those with any DU behavior.
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Affiliation(s)
- Matthew B Feldman
- New York City Department of Health and Mental Hygiene, Bureau of HIV/AIDS Prevention and Control, 42-09 28th Street, Queens, NY, 11101-4132, USA.
| | - Kelsey L Kepler
- New York City Department of Health and Mental Hygiene, Bureau of HIV/AIDS Prevention and Control, 42-09 28th Street, Queens, NY, 11101-4132, USA
| | - Mary K Irvine
- New York City Department of Health and Mental Hygiene, Bureau of HIV/AIDS Prevention and Control, 42-09 28th Street, Queens, NY, 11101-4132, USA
| | - Jacinthe A Thomas
- New York City Department of Health and Mental Hygiene, Bureau of HIV/AIDS Prevention and Control, 42-09 28th Street, Queens, NY, 11101-4132, USA
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11
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Nash D, Robertson MM, Penrose K, Chamberlin S, Robbins RS, Braunstein SL, Myers JE, Abraham B, Kulkarni S, Waldron L, Levin B, Irvine MK. Short-term effectiveness of HIV care coordination among persons with recent HIV diagnosis or history of poor HIV outcomes. PLoS One 2018; 13:e0204017. [PMID: 30248136 PMCID: PMC6152971 DOI: 10.1371/journal.pone.0204017] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2018] [Accepted: 08/31/2018] [Indexed: 11/25/2022] Open
Abstract
The 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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Affiliation(s)
- Denis Nash
- Institute for Implementation Science in Population Health, City University of New York, New York, NY United States of America
- Graduate School of Public Health and Health Policy, City University of New York, New York, NY United States of America
- * E-mail:
| | - McKaylee M. Robertson
- Institute for Implementation Science in Population Health, City University of New York, New York, NY United States of America
- Graduate School of Public Health and Health Policy, City University of New York, New York, NY United States of America
| | - Kate Penrose
- Bureau of HIV/AIDS, New York City Department of Health and Mental Hygiene, New York, NY United States of America
| | - Stephanie Chamberlin
- Bureau of HIV/AIDS, New York City Department of Health and Mental Hygiene, New York, NY United States of America
| | - Rebekkah S. Robbins
- Bureau of HIV/AIDS, New York City Department of Health and Mental Hygiene, New York, NY United States of America
| | - Sarah L. Braunstein
- Bureau of HIV/AIDS, New York City Department of Health and Mental Hygiene, New York, NY United States of America
| | - Julie E. Myers
- Bureau of HIV/AIDS, New York City Department of Health and Mental Hygiene, New York, NY United States of America
- Division of Infectious Diseases, Department of Medicine, Columbia University College of Physicians and Surgeons, New York, NY United States of America
| | - Bisrat Abraham
- Bureau of HIV/AIDS, New York City Department of Health and Mental Hygiene, New York, NY United States of America
| | - Sarah Kulkarni
- Institute for Implementation Science in Population Health, City University of New York, New York, NY United States of America
- Graduate School of Public Health and Health Policy, City University of New York, New York, NY United States of America
| | - Levi Waldron
- Institute for Implementation Science in Population Health, City University of New York, New York, NY United States of America
- Graduate School of Public Health and Health Policy, City University of New York, New York, NY United States of America
| | - Bruce Levin
- Department of Biostatistics, Mailman School of Public Health, Columbia University, New York, NY United States of America
| | - Mary K. Irvine
- Bureau of HIV/AIDS, New York City Department of Health and Mental Hygiene, New York, NY United States of America
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12
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Robertson MM, Waldron L, Robbins RS, Chamberlin S, Penrose K, Levin B, Kulkarni S, Braunstein SL, Irvine MK, Nash D. Using Registry Data to Construct a Comparison Group for Programmatic Effectiveness Evaluation: The New York City HIV Care Coordination Program. Am J Epidemiol 2018; 187:1980-1989. [PMID: 29788080 DOI: 10.1093/aje/kwy103] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2017] [Accepted: 05/02/2018] [Indexed: 12/25/2022] Open
Abstract
Many nonrandomized interventions rely upon a pre-post design to evaluate effectiveness. Such designs cannot account for events external to the intervention that may produce the outcome. We describe a method to construct a surveillance registry-based comparison group, which allows for estimating the effectiveness of the intervention while controlling for secular trends in the outcome of interest. Using data from the population-based, human immunodeficiency virus Surveillance Registry in New York City, we created a contemporaneous comparison group for persons enrolled in the New York City human immunodeficiency virus Care Coordination Program (CCP) from December 2009 to March 2013. Inclusion in the Registry-based (non-CCP) comparison group required meeting CCP eligibility criteria. To control for secular trends in the outcome, we randomly assigned persons in the non-CCP, Registry-based comparison group a pseudoenrollment date such that the distribution of pseudoenrollment dates matched the distribution of enrollment dates among CCP enrollees. We then matched CCP to non-CCP persons on propensity for enrollment in the CCP, enrollment dates, and baseline viral load. Registry-based comparison group estimates were attenuated relative to pre-post estimates of program effectiveness. These methods have broad applicability for observational intervention effectiveness studies and programmatic evaluations for conditions with surveillance registries.
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Affiliation(s)
- McKaylee M Robertson
- Institute for Implementation Science in Population Health, Graduate School of Public Health and Health Policy, City University of New York, New York, New York
| | - Levi Waldron
- Institute for Implementation Science in Population Health, Graduate School of Public Health and Health Policy, City University of New York, New York, New York
| | - Rebekkah S Robbins
- Bureau of HIV/AIDS Prevention and Control, New York City Department of Health and Mental Hygiene, New York, New York
| | - Stephanie Chamberlin
- Bureau of HIV/AIDS Prevention and Control, New York City Department of Health and Mental Hygiene, New York, New York
| | - Kate Penrose
- Bureau of HIV/AIDS Prevention and Control, New York City Department of Health and Mental Hygiene, New York, New York
| | - Bruce Levin
- Department of Biostatistics, Mailman School of Public Health, Columbia University, New York, New York
| | - Sarah Kulkarni
- Institute for Implementation Science in Population Health, Graduate School of Public Health and Health Policy, City University of New York, New York, New York
| | - Sarah L Braunstein
- Bureau of HIV/AIDS Prevention and Control, New York City Department of Health and Mental Hygiene, New York, New York
| | - Mary K Irvine
- Bureau of HIV/AIDS Prevention and Control, New York City Department of Health and Mental Hygiene, New York, New York
| | - Denis Nash
- Institute for Implementation Science in Population Health, Graduate School of Public Health and Health Policy, City University of New York, New York, New York
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13
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Irvine MK, Chamberlin SA, Robbins RS, Kulkarni SG, Robertson MM, Nash D. Come as You Are: Improving Care Engagement and Viral Load Suppression Among HIV Care Coordination Clients with Lower Mental Health Functioning, Unstable Housing, and Hard Drug Use. AIDS Behav 2017; 21:1572-1579. [PMID: 27342990 DOI: 10.1007/s10461-016-1460-4] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Lower mental health functioning, unstable housing, and drug use can complicate HIV clinical management. Merging programmatic and surveillance data, we examined characteristics and outcomes for HIV Care Coordination clients enrolled between December 2009 and March 2013. For clients diagnosed over 12 months before enrollment, we calculated post- versus pre-enrollment relative risks for short-term (12-month) care engagement and viral suppression. Both outcomes significantly improved in all subgroups, including those with lower mental health functioning, unstable housing, or hard drug use. Analyses further stratified within barrier-affected groups showed a tendency toward greater improvement when that barrier was reduced during the follow-up year.
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Affiliation(s)
- Mary K Irvine
- The Bureau of HIV/AIDS Prevention and Control, New York City Department of Health and Mental Hygiene, 42-09 28th Street, Queens, New York, NY, 11101-4132, USA
| | - Stephanie A Chamberlin
- The Bureau of HIV/AIDS Prevention and Control, New York City Department of Health and Mental Hygiene, 42-09 28th Street, Queens, New York, NY, 11101-4132, USA.
| | - Rebekkah S Robbins
- The Bureau of HIV/AIDS Prevention and Control, New York City Department of Health and Mental Hygiene, 42-09 28th Street, Queens, New York, NY, 11101-4132, USA
| | - Sarah G Kulkarni
- Graduate School of Public Health and Health Policy, The City University of New York, 55 West 125th Street, New York, 10027, NY, USA
- Institute for Implementation Science in Population Health, The City University of New York, 55 West 125th Street, New York, 10027, NY, USA
| | - McKaylee M Robertson
- Graduate School of Public Health and Health Policy, The City University of New York, 55 West 125th Street, New York, 10027, NY, USA
| | - Denis Nash
- Graduate School of Public Health and Health Policy, The City University of New York, 55 West 125th Street, New York, 10027, NY, USA
- Institute for Implementation Science in Population Health, The City University of New York, 55 West 125th Street, New York, 10027, NY, USA
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14
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Hile SJ, Feldman MB, Raker AR, Irvine MK. Identifying Key Elements to Inform the Development of an HIV Health Behavior Maintenance Intervention. Am J Health Promot 2016; 32:48-58. [PMID: 27765879 DOI: 10.1177/0890117116669108] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
PURPOSE To collect information that will inform the development of an intervention to support the maintenance of HIV-related health-promoting behaviors. DESIGN Focused, in-depth individual and group interviews. SETTING The New York City (NYC) Department of Health and Mental Hygiene (DOHMH) and DOHMH-funded community-based organizations that primarily serve low-income people living with HIV within the five boroughs of NYC. PARTICIPANTS A total of 42 individuals who had participated in The Positive Life Workshop-an HIV self-management intervention adapted and implemented by the NYC DOHMH. METHOD Purposive sampling was used to recruit study participants. Five 60- to 90-minute focus groups (n = 38) and 4 individual interviews were conducted to assess motivations for and barriers to maintaining HIV-related health-promoting behaviors and to elicit feedback on the content and format for the proposed maintenance intervention. Thematic analysis was used to summarize the data. RESULTS Participants reported that relationships with family, a responsibility to protect others from HIV, and faith/spirituality supported the maintenance of health-promoting behaviors. Barriers to behavior maintenance included substance use and mental health issues. Meeting in small groups was also highlighted as a motivator to sustaining health behaviors, particularly in decreasing isolation and receiving affirmation from others. CONCLUSION Participants identified several factors that could be incorporated into an intervention to support HIV-related health-promoting behavior maintenance that could supplement existing HIV self-management interventions.
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Affiliation(s)
- Stephen J Hile
- 1 New York City Department of Health and Mental Hygiene, Bureau of HIV/AIDS Prevention and Control, Queens, NY, USA
| | - Matthew B Feldman
- 1 New York City Department of Health and Mental Hygiene, Bureau of HIV/AIDS Prevention and Control, Queens, NY, USA
| | - Amanda R Raker
- 1 New York City Department of Health and Mental Hygiene, Bureau of HIV/AIDS Prevention and Control, Queens, NY, USA
| | - Mary K Irvine
- 1 New York City Department of Health and Mental Hygiene, Bureau of HIV/AIDS Prevention and Control, Queens, NY, USA
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15
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Hile SJ, Feldman MB, Alexy ER, Irvine MK. Recent Tobacco Smoking is Associated with Poor HIV Medical Outcomes Among HIV-Infected Individuals in New York. AIDS Behav 2016; 20:1722-9. [PMID: 26837623 PMCID: PMC4942487 DOI: 10.1007/s10461-015-1273-x] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Tobacco smoking is associated with adverse health effects among people living with HIV (PLWH), including a higher risk of cancer and cardiovascular problems. Further, there is evidence that PLWH are two to three times more likely to smoke than the general population. The aim of this study was to examine the association between tobacco smoking and biomarkers of HIV disease progression, including unsuppressed viral load (viral load >200 copies/mL) and low CD4 cell count (<200 cells/mm(3)). Recent tobacco smoking was reported by 40 % (n = 5942) of 14,713 PLWH enrolled in Ryan White Part A programs in the New York City metropolitan area. In multivariate analyses controlling for sociodemographic and clinical characteristics, recent tobacco smoking was independently associated with unsuppressed viral load (AOR = 1.38, CI 1.26-1.50) and low CD4 cell count (AOR = 1.12, CI 1.01-1.24). Findings suggest the importance of routine assessments of tobacco use in clinical care settings for PLWH.
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16
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Abstract
The federal Housing Opportunities for Persons with AIDS (HOPWA) program addresses housing needs of low-income persons living with HIV/AIDS (PLWHA). The New York City (NYC) Department of Health and Mental Hygiene oversees 22 HOPWA contracts for over 2,400 clients, and manages the NYC HIV Registry. HOPWA clients (N = 1,357) were matched to a random 20 % sample of other PLWHA (N = 13,489). Groups were compared on HIV care retention, viral suppression, and rebound. HOPWA clients were, on average, 3 years younger and more likely to be concurrently diagnosed with HIV and AIDS. While HOPWA clients were more likely to be retained in care (94 vs. 82 %; mOR = 2.97, 95 % CI 2.35-3.74), they were no more likely to achieve suppression (84 vs. 86 %; mOR = 0.85, 95 % 0.70-1.03) and were more likely to rebound (11 vs. 7 %; mOR = 1.45; 95 % CI 1.10-1.91). HIV care retention does not fully translate to virologic suppression in this low-income service population.
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Affiliation(s)
- Arpi S Terzian
- New York City Department of Health and Mental Hygiene, Queens, New York, NY, 11101, USA.
| | - Mary K Irvine
- New York City Department of Health and Mental Hygiene, Queens, New York, NY, 11101, USA
| | - Laura M Hollod
- New York City Department of Health and Mental Hygiene, Queens, New York, NY, 11101, USA
| | - Sungwoo Lim
- New York City Department of Health and Mental Hygiene, Queens, New York, NY, 11101, USA
| | - John Rojas
- New York City Department of Health and Mental Hygiene, Queens, New York, NY, 11101, USA
| | - Colin W Shepard
- New York City Department of Health and Mental Hygiene, Queens, New York, NY, 11101, USA
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17
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Feldman MB, Thomas JA, Alexy ER, Irvine MK. Crystal methamphetamine use and HIV medical outcomes among HIV-infected men who have sex with men accessing support services in New York. Drug Alcohol Depend 2015; 147:266-71. [PMID: 25482501 DOI: 10.1016/j.drugalcdep.2014.09.780] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2014] [Revised: 09/23/2014] [Accepted: 09/26/2014] [Indexed: 11/17/2022]
Abstract
BACKGROUND Drug use poses multiple challenges to maintaining physical health among HIV-infected individuals, particularly with regard to disease progression. Few studies, however, have examined the association between the use of crystal methamphetamine ("crystal meth") and HIV disease progression specifically among HIV-infected men who have sex with men (MSM). Understanding this relationship among HIV-infected MSM is particularly critical because of the high rates of crystal meth use reported in the population. METHODS Associations between recent crystal meth use and poor HIV medical outcomes (viral load>200 copies/mL, CD4 count <350 cells/mm(3)) were analyzed for 2896 HIV-infected MSM enrolled in Ryan White Part A programs in the greater New York metropolitan area between November 2010 and June 2012. RESULTS Crystal meth use (reported by 4%) was independently associated with unsuppressed viral load (AOR=1.8, CI=1.1-2.9) in multivariate analyses controlling for sociodemographic characteristics. There was no significant relationship between crystal meth use and low CD4 counts. CONCLUSIONS To date, little research has examined how crystal meth use influences HIV medical outcomes among HIV-infected MSM. This analysis showed a significant independent association between crystal meth use and unsuppressed viral load among MSM in an HIV service population. Future studies should examine biological and psychosocial mediators, moderators and confounders of this relationship to inform intervention development for MSM crystal meth users in HIV care settings.
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Affiliation(s)
- Matthew B Feldman
- New York City Department of Health and Mental Hygiene, Bureau of HIV/AIDS Prevention and Control, 42-09 28th Street, Queens, NY 11101-4132, United States.
| | - Jacinthe A Thomas
- New York City Department of Health and Mental Hygiene, Bureau of HIV/AIDS Prevention and Control, 42-09 28th Street, Queens, NY 11101-4132, United States
| | - Emily R Alexy
- New York City Department of Health and Mental Hygiene, Bureau of HIV/AIDS Prevention and Control, 42-09 28th Street, Queens, NY 11101-4132, United States
| | - Mary K Irvine
- New York City Department of Health and Mental Hygiene, Bureau of HIV/AIDS Prevention and Control, 42-09 28th Street, Queens, NY 11101-4132, United States
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18
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Irvine MK, Chamberlin SA, Robbins RS, Myers JE, Braunstein SL, Mitts BJ, Harriman GA, Laraque F, Nash D. Improvements in HIV care engagement and viral load suppression following enrollment in a comprehensive HIV care coordination program. Clin Infect Dis 2014; 60:298-310. [PMID: 25301208 DOI: 10.1093/cid/ciu783] [Citation(s) in RCA: 85] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Substantial evidence gaps remain regarding human immunodeficiency virus (HIV) intervention strategies that improve engagement in care (EiC) and viral load suppression (VLS). We assessed EiC and VLS before and after enrollment in a comprehensive intervention for persons at risk of poor HIV care outcomes. METHODS New York City's Ryan White Part A HIV Care Coordination Program (CCP), launched at 28 agencies in 2009, applies multiple strategies to promote optimal utilization of medical and social services. Using laboratory test records from an HIV surveillance registry, we examined pre-post outcomes among 3641 CCP clients enrolled before April 2011. For the year before and after enrollment, we assessed EiC (defined as ≥2 tests, ≥90 days apart, with ≥1 in each half-year) and VLS (defined as viral load [VL] ≤200 copies/mL on latest VL test in the second half of the year). We estimated relative risks (RRs), comparing pre- and postenrollment proportions achieving EiC and VLS. RESULTS Among newly diagnosed clients, 90.5% (95% confidence interval [CI], 87.9%-93.2%) and 66.2% (95% CI, 61.9%-70.6%) achieved EiC and VLS, respectively. Among previously diagnosed clients, EiC increased from 73.7% to 91.3% (RR = 1.24; 95% CI, 1.21-1.27) and VLS increased from 32.3% to 50.9% (RR = 1.58; 95% CI, 1.50-1.66). Clients without evidence of HIV care during the 6 months preenrollment contributed most to overall improvements. Pre-post improvements were robust, retaining statistical significance within most sociodemographic and clinical subgroups, and in 89% (EiC) and 75% (VLS) of CCP agencies. CONCLUSIONS Clients in comprehensive HIV care coordination for persons with evident barriers to care showed substantial and consistent improvement in short-term outcomes.
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Affiliation(s)
- Mary K Irvine
- Bureau of HIV/AIDS Prevention and Control, New York City Department of Health and Mental Hygiene
| | - Stephanie A Chamberlin
- Bureau of HIV/AIDS Prevention and Control, New York City Department of Health and Mental Hygiene
| | - Rebekkah S Robbins
- Bureau of HIV/AIDS Prevention and Control, New York City Department of Health and Mental Hygiene
| | - Julie E Myers
- Bureau of HIV/AIDS Prevention and Control, New York City Department of Health and Mental Hygiene Division of Infectious Diseases, Department of Medicine, Columbia University Medical Center
| | - Sarah L Braunstein
- Bureau of HIV/AIDS Prevention and Control, New York City Department of Health and Mental Hygiene
| | - Beau J Mitts
- Bureau of HIV/AIDS Prevention and Control, New York City Department of Health and Mental Hygiene
| | - Graham A Harriman
- Bureau of HIV/AIDS Prevention and Control, New York City Department of Health and Mental Hygiene
| | | | - Denis Nash
- School of Public Health Hunter College, The City University of New York, New York
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19
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Renaud TC, Bocour A, Irvine MK, Bernstein KT, Begier EM, Sepkowitz KA, Kellerman SE, Weglein D. The free condom initiative: promoting condom availability and use in New York City. Public Health Rep 2009; 124:481-9. [PMID: 19618784 DOI: 10.1177/003335490912400404] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
In 2005, the New York City Department of Health and Mental Hygiene (DOHMH) made free condoms available to organizations through a Web-based ordering system. In 2006, we interviewed managers and patrons about free condom availability, acquisition, and use in venues where people at high risk for human immunodeficiency virus congregate. DOHMH condom distribution increased from 5.8 million in 2004 to 17.3 million in 2006. Overall, managers reported making condoms available at 76% (309/409) of high-priority venues, but only at 40% of gay bars. Among patrons who saw free condoms, 80% (280/351) reported taking them; 73% (205/280) of those who reported taking them also reported using them. A simple, Web-based ordering system dramatically increased condom distribution. In the venues we sampled, the majority of patrons acquired and used free condoms when available and visible, suggesting that increasing free condom availability may increase use. Special efforts are needed to ensure availability at gay bars.
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Affiliation(s)
- Tamar C Renaud
- Bureau of HIV Prevention and Control, New York City Department of Health and Mental Hygiene, New York, NY 10013, USA.
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20
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Steele RJ, Walker WS, Irvine MK, Lee D, Taylor TV. The use of doxapram in the prevention of postoperative pulmonary complications. Surg Gynecol Obstet 1982; 154:510-2. [PMID: 7038950] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
A prospective, double-blind, randomized controlled clinical trial has been conducted to assess the effect of doxapram hydrochloride infusions on pulmonary complications in patients undergoing extensive abdominal operations. For the purposes of this study, a pulmonary complication was defined as the production of purulent sputum or the presence of any abnormal clinical or roentgenologic chest signs. Of the 53 control patients, 41 had chest problems develop by these criteria, whereas the same was true of only 20 of the 40 patients receiving doxapram. The average duration of hospitalization was one day less for those receiving the drug.
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