The Impact of Integrated HIV Care on Patient Health Outcomes

Bibliographic Data

ID9099995
AuthorsTuyen Hoang (VA Greater Los Angeles Healthcare System, corresponding author), Matthew Bidwell Goetz (0000-0003-4542-992X, VA Greater Los Angeles Healthcare System), Elizabeth M Yano (0000-0002-9385-0025, Health Services Research & Development, corresponding author), Barbara Rossman (VA Greater Los Angeles Healthcare System), Henry D Anaya (Health Services Research & Development, corresponding author), Herschel Knapp (0000-0003-0964-2889, VA Greater Los Angeles Healthcare System, corresponding author), P Todd Korthuis (0000-0001-5556-3597, Oregon Health & Science University), Randal Henry (VA Greater Los Angeles Healthcare System, corresponding author), Candice Bowman (0000-0001-8043-9563, VA San Diego Healthcare System), Allen L Gifford (0000-0001-6442-1128, Edith Nourse Rogers Memorial Veterans Hospital), Allen Gifford, Steven M Asch (0000-0001-5838-5335, VA Greater Los Angeles Healthcare System, corresponding author)
Year2009
Volume47
Issue5
Pages560-567
Publication date2009-05-01
Peer ReviewedYes
Open AccessNo
TypeARTICLE
VenueMedical Care (JOURNAL)
Journal identifiersISSN: 0025-7079 • E-ISSN: 1537-1948
PublisherOvid Technologies (Wolters Kluwer Health) (PUBLISHER)
DOI10.1097/mlr.0b013e31819432a0
PMID19318998
PMCIDPMC3108041
OpenAlexW1989415380
LanguageEN
Citations received10
References cited41

BACKGROUND: Control of viral replication through combination antiretroviral therapy (cART) improves patient health outcomes. Yet many HIV-infected patients have comorbidities that pose social and clinical barriers to achieving viral suppression. Integration of subspecialty services into HIV primary care may overcome such barriers. OBJECTIVE: To evaluate effect of integrated HIV care (IHC) on suppression of HIV replication. RESEARCH DESIGN: A retrospective cohort study of HIV patients from 5 Veterans Affairs healthcare facilities 2000 to 2006. SUBJECTS: Patients with >3 months of follow-up, sufficient baseline HIV severity, on cART. MEASURES: We measured and ranked Integrated Care at the facilities. These rankings were applied to patient visits to form an index of IHC utilization. We evaluated effect of IHC utilization on likelihood of achieving viral suppression while on cART, controlling for demographic and clinical factors using survival analysis. RESULTS: : The 1018 HIV-infected patients eligible for analysis had substantial barriers to responding to cART: 93% had comorbidities with mean 3.2 comorbidities per patient (SD = 2.0); 52% achieved viral suppression in median 231 days (SD = 411.6). Patients visiting clinics that offered hepatitis, psychiatric, psychologic, and social services in addition to HIV primary care were 3.1 times more likely to achieve viral suppression than patients visiting clinics which offered only HIV primary care (hazard ratio = 3.1, P < 0.001). CONCLUSIONS: Patients who visited IHC clinics were more likely to achieve viral suppression while on cART. Future research should investigate which elements of Integrated Care are most associated with viral control and what role provider experience plays in this association

Cart · Cohort · Confidence interval · Family medicine · Hazard ratio · Health care · Human immunodeficiency virus (HIV) · Integrated care · Retrospective cohort study · Subspecialty · Veterans Affairs · Viral load · Emergency Medicine · HIV-related health complications and treatments · HIV/AIDS Research and Interventions · Internal Medicine · Medicine · Pneumocystis jirovecii pneumonia detection and treatment

Tools

Open DOISci-Hub