305573
Robust short-term effectiveness of a comprehensive HIV care coordination program in New York City (NYC)
Evidence is needed regarding HIV interventions improving engagement in care (EiC) and viral load suppression (VLS). We assessed subgroup differences in EiC and VLS change following enrollment into a comprehensive medical case management intervention, the NYC Ryan White HIV Care Coordination Program (CCP).
Methods:
Using local program and laboratory records from surveillance, we examined pre- and post-enrollment outcomes for 3,176 clients enrolled before April 2011 and diagnosed >1 year before enrollment in CCP at 28 agencies. For the year before and after enrollment, we estimated EiC (≥2 tests ≥90 days apart, ≥1 in each half-year) and VLS (VL ≤200 copies/mL on latest test in the second half of the year). Relative risks (RRs) and confidence intervals (CIs) for the outcomes were estimated using generalized estimating equations.
Results:
The proportions with EiC and VLS increased from 74% to 91% (RREiC=1.24, 95% CI: 1.21-1.27) and from 32% to 51% (RRVLS=1.58, 95% CI: 1.50-1.66). Significant improvements held across subgroups, except clients with baseline CD4 ≥500 (VLS only) or “other/unknown” race (EiC only). The greatest improvements were among those who were age < 45, diagnosed >2004, not prescribed antiretrovirals, male (EiC only), making <$9,000/year (EiC only), uninsured (EiC only), homeless (EiC only), unsuppressed (EiC only), and CD4 <200 (VLS only) at enrollment. Significant improvements were observed for EiC at 25 (89%) and VLS at 21 (75%) of 28 agencies.
Conclusions:
EiC and VLS improvements were robust across most subgroups. Differences found suggest the value of targeting recruitment to those with evident care/treatment barriers.
Learning Areas:
EpidemiologyPublic health or related education
Learning Objectives:
Demonstrate sub-group differences in care engagement and viral load suppression among participants in a comprehensive HIV care coordination program.
Keyword(s): Adherence, HIV/AIDS
Qualified on the content I am responsible for because: I have over eight years of program evaluation experience directly related to social policy, specifically the delivery of health services to under-served populations. I have worked in various capacities across 15 countries to enhance monitoring and evaluation efforts and the development of programs targeting complex social issues, including HIV prevention and treatment programs. I received my Master of Public Health and Mater of International Affairs degrees from Columbia University.
Any relevant financial relationships? No
I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.