Improved Viral Suppression from a Coordinated HIV Care Program: Impact of Key Comorbidities

摘要

Care coordination doubled viral suppression rates, although benefits were diminished by housing instability, stimulant use, and multiple comorbidities. Assessments of obstacles to improved HIV-cascade care have identified populations at risk for poor outcomes. To address those populations (defined as newly HIV diagnosed or out-of-care patients, patients never prescribed antiretroviral therapy [ART] or on ART but with HIV levels >200 copies/mL, or patients with a new sexually transmitted disease within the last 6 months), Los Angeles County implemented a medical care coordination program. The program included outreach to newly diagnosed and out-of-care persons, linkage to care providers, assistance with navigation including accompaniment to appointments, ART adherence guidance, and warm hand-off referrals to mental health, chemical-dependency, and housing services. These researchers analyzed data from 35 clinics participating in the program from January 1,2013, to September 31, 2017, representing 6408 persons. They assessed factors associated with viral suppression (defined as <200 copies HIV RNA/mL) from 12 months before enrollment through 36 months postenrollment. The probability of suppression increased from 0.35 to 0.77 within the first 6 months after enrollment — an effect that was maintained for up to 36 months. Patients reporting housing instability, stimulant use, or multiple comorbid conditions did not achieve the same level of viral suppression by 36 months.