HIV Care Coordination promotes care re-engagement and viral suppression among people who have been out of HIV medical care: an observational effectiveness study using a surveillance-based contemporaneous comparison group.
HIV Care Coordination promotes care re-engagement and viral suppression among people who have been out of HIV medical care: an observational effectiveness study using a surveillance-based contemporaneous comparison group.
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艾滋病毒护理协调促进了脱离艾滋病毒医疗护理的人的护理重新参与和病毒抑制：使用基于监视的同时比较组的观察有效性研究。
DOI：
10.1186/s12981-021-00398-0
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发表时间：
2021-10-12
影响因子：
2.2
通讯作者：
Levin B
中科院分区：
文献类型：
--
作者：
Irvine MK;Robertson MM;Nash D;Kulkarni SG;Braunstein SL;Levin B
医疗保健的重新参与是至关重要的抑制病毒载量和预防艾滋病毒的传播，发病率和死亡率，但很少有严格的干预研究解决这一结果。我们评估了瑞安白色A部分资助的艾滋病毒护理协调计划相对于“常规护理”的有效性，用于近期没有艾滋病毒医疗护理的人的短期护理重新参与和病毒抑制。护理协调计划于2009年在纽约市的28家医院、卫生中心和社区组织启动。护理协调计划专为艾滋病毒感染者（PWH）经历或面临艾滋病毒不良后果的风险而设计，利用跨学科团队，结构化健康教育和患者导航提供长期，全面的医疗病例管理。该干预措施是作为一项安全网服务计划实施的，没有指定比较组。为了进行回顾性评估，我们创建了一个观察性的，匹配的客户和控制队列。使用HIV监测登记处，我们确定了2009年12月1日至2013年3月31日期间符合计划资格标准的个人，并排除了在12个月随访前死亡的人。然后，我们根据基线状态（缺乏病毒抑制的证据，持续抑制，不一致抑制或在过去12个月内新诊断），随访开始和倾向评分将客户与对照组进行匹配。对于该分析，我们仅限于基线时未接受治疗的患者（定义为入组前12个月内未进行病毒载量检测）和仍居住在管辖范围内的患者（定义为向当地监测机构报告病毒载量或CD 4检测结果，日期在12个月随访期内）。使用具有二进制误差分布和logit链接的GEE模型，我们比较了12个月随访时重新参与护理（定义为间隔≥ 90天发生≥ 2起实验室事件）和病毒抑制（定义为最近一次病毒载量检测中HIV RNA ≤ 200拷贝/mL）的几率。在326名基线时未接受护理的患者中，87.2%的客户和48.2%的对照组实现了护理再参与（比值比：4.53; 95%CI 2.66，7.71）; 58.3%的客户和49.3%的对照组实现了病毒抑制（比值比：2.05; 95%CI 1.30，3.23）。艾滋病毒护理协调显示出重新参与护理和治疗的有效性。
Medical care re-engagement is critical to suppressing viral load and preventing HIV transmission, morbidity and mortality, yet few rigorous intervention studies address this outcome. We assessed the effectiveness of a Ryan White Part A-funded HIV Care Coordination Program relative to ‘usual care,’ for short-term care re-engagement and viral suppression among people without recent HIV medical care. The Care Coordination Program was launched in 2009 at 28 hospitals, health centers, and community-based organizations in New York City. Designed for people with HIV (PWH) experiencing or at risk for poor HIV outcomes, the Care Coordination Program provides long-term, comprehensive medical case management utilizing interdisciplinary teams, structured health education and patient navigation. The intervention was implemented as a safety-net services program, without a designated comparison group. To evaluate it retrospectively, we created an observational, matched cohort of clients and controls. Using the HIV surveillance registry, we identified individuals meeting program eligibility criteria from December 1, 2009 to March 31, 2013 and excluded those dying prior to 12 months of follow-up. We then matched clients to controls on baseline status (lacking evidence of viral suppression, consistently suppressed, inconsistently suppressed, or newly diagnosed in the past 12 months), start of follow-up and propensity score. For this analysis, we limited to those out of care at baseline (defined as having no viral load test in the 12 months pre-enrollment) and still residing within jurisdiction (defined as having a viral load or CD4 test reported to local surveillance and dated within the 12-month follow-up period). Using a GEE model with binary error distribution and logit link, we compared odds of care re-engagement (defined as having ≥ 2 laboratory events ≥ 90 days apart) and viral suppression (defined as having HIV RNA ≤ 200 copies/mL on the most recent viral load test) at 12-month follow-up. Among 326 individuals out of care at baseline, 87.2% of clients and 48.2% of controls achieved care re-engagement (Odds Ratio: 4.53; 95%CI 2.66, 7.71); 58.3% of clients and 49.3% of controls achieved viral suppression (Odds Ratio: 2.05; 95%CI 1.30, 3.23). HIV Care Coordination shows evidence of effectiveness for care and treatment re-engagement.
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影响因子：
4.4
作者：
Risher KA;Kapoor S;Daramola AM;Paz-Bailey G;Skarbinski J;Doyle K;Shearer K;Dowdy D;Rosenberg E;Sullivan P;Shah M
通讯作者：
Shah M
影响因子：
4.9
作者：
Bradford, Judith B.;Coleman, Sharon;Cunningham, William
通讯作者：
Cunningham, William
影响因子：
2
作者：
Rubin, Donald B.
通讯作者：
Rubin, Donald B.
影响因子：
158.5
作者：
Danel, Christine;Moh, Raoul;Anglaret, Xavier
通讯作者：
Anglaret, Xavier
影响因子：
5
作者：
Robertson, McKaylee M.;Waldron, Levi;Nash, Denis
通讯作者：
Nash, Denis