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Impact of an HIV Care Coordination Program on the Timeliness of Viral Suppression and Immune Recovery Among Clients Newly Diagnosed with HIV

  • McKaylee M. RobertsonEmail author
  • Kate Penrose
  • Denis Nash
  • Graham Harriman
  • Sarah L. Braunstein
  • Bruce Levin
  • Mary K. Irvine
Original Paper
  • 28 Downloads

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.

Keywords

HIV Viral suppression Medical case management Immunologic recovery New HIV diagnoses Care coordination Comparative effectiveness 

Resumen

Hemos comparado el tiempo de recuperación del sistema inmunológico y la supresión viral (VS) entre personas recién diagnosticadas con VIH inscritas en el Programa de Coordinación de Atención del VIH (PCC), un programa integral que maneja casos médicos, con un grupo de personas diagnosticadas recientemente que no se inscribieron en el programa. Los inscritos en PCC tuvieron una supresión viral VS más rápida (≤ 200 copias/ml) (razón de riesgos [HR] 1.17; intervalo de confianza del 95% 1.02-1.34) pero no presentaron una recuperación inmune más rápida (≥ dos recuentos sucesivos de CD4 > 500 células/mm3) (HR: 0,98; 0,84-1,13). En relación con la atención habitual, el CCP puede acelerar la supresión viral VS (pero no la recuperación inmune) para los pacientes con VIH recién diagnosticados y, por lo tanto, reduce el riesgo de transmisión en lo sucesivo.

Notes

Acknowledgements

The authors are indebted to: Kate Taylor for assistance with manuscript preparation, the Ryan White Part A Care Coordination Program staff for their dedication to the delivery of comprehensive services, their continual participation in reporting on this intervention, and their shared commitment to rigorous evaluation and the integration of findings into practice; and the members of the study Community Advisory Board, for their guidance and critical input at various stages of this work. This work was completed as part of the Costs, Health Outcomes and Real-world Determinants of Success in HIV Care Coordination (CHORDS) Study.

Funding

This work was supported by the National Institute of Mental Health of the National Institutes of Health (Grant No. R01 MH101028).

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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Institute for Implementation Science in Population Health (ISPH)City University of New York (CUNY)New York CityUSA
  2. 2.Graduate School of Public Health and Health PolicyCity University of New York (CUNY)New York CityUSA
  3. 3.Bureau of HIV/AIDS Prevention and ControlNew York City Department of Health and Mental HygieneNew York CityUSA
  4. 4.Department of Biostatistics, Mailman School of Public HealthColumbia UniversityNew YorkUSA

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