Comparison of HIV Outcomes for Patients Linked at Hospital Versus Community-Based Clinics

Schranz, Asher J; Brady, Kathleen A.; Momplaisir, Florence; Metlay, Joshua P.; Stephens, Alisa; Yehia, Baligh R.

doi:10.1089/apc.2014.0199

Cited by 10 publications

(8 citation statements)

References 50 publications

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“…Interestingly, we also observed differences by clinic type with participants at community-based clinics having more regular VL monitoring and better retention in care than those enrolled at hospital-based clinics. This observation differs from that of other studies that did not find meaningful differences in retention with respect to clinic type [ 38 , 39 ]. Further exploration of patient characteristics by site, as well as characterization of care delivery such as the receipt of primary care and availability of ancillary services at each site, as well as the costs of providing these services, is necessary to fully understand the implications of these findings.…”

Section: Discussioncontrasting

confidence: 99%

Use of national standards to monitor HIV care and treatment in a high prevalence city—Washington, DC

et al. 2017

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We sought to benchmark the quality of HIV care being received by persons living with HIV in care in Washington, DC and identify individual-level and structural-level differences. Data from the DC Cohort, an observational HIV cohort of persons receiving outpatient care in DC, were used to estimate the Institute of Medicine (IOM) and Department of Health and Human Services (HHS) quality of care measures. Differences in care by demographics and clinic type were assessed using χ2 tests and multivariable regression models. Among 8,047 participants, by HHS standards, 69% of participants were retained in care (RIC), 95% were prescribed antiretroviral therapy (ART), and 84% were virally suppressed (VS). By IOM standards, 84% were in continuous care; and 78% and 80% underwent regular CD4 and VL monitoring, respectively. Screening for syphilis, chlamydia, and gonorrhea was 51%, 31%, and 26%, respectively. Older participants were 1.5 times more likely to be RIC compared to younger participants (OR: 1.5; 95% CI: 1.3, 1.8). Participants enrolled in community-based clinics were more likely to be RIC (OR: 1.7; 95% CI: 1.4, 2.0) versus those enrolled at hospital-based clinics. Older participants were more likely to achieve VS than younger participants (OR: 1.8; 95% CI: 1.5, 2.2) while Black participants were less likely compared to white participants (OR: 0.4; 95% CI: 0.3, 0.5). Despite high measures of quality of care, disparities remain. Continued monitoring of the quality of HIV care and treatment can inform the development of public health programs and interventions to optimize care delivery.

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Section: Discussioncontrasting

confidence: 99%

Use of national standards to monitor HIV care and treatment in a high prevalence city—Washington, DC

et al. 2017

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“…Compared with those studies using the data from major health care facilities, such as urban hospitals, our study showed similar clinical outcomes. This finding suggests that the HIV care can be delivered effectively in community settings, which was also supported by the research conducted in other settings [35, 36].…”

Section: Discussionsupporting

confidence: 74%

Immunological and virologic outcomes of people living with HIV in Guangxi, China: 2012-2017

Yang

Qiao

et al. 2019

PLoS ONE

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Background Limited data are available on clinical outcomes of people living with HIV (PLWH) in China, especially after the implementation of the 2016 national treatment guideline. The objective of the current study is to examine the treatment patterns, clinical outcomes and their associated factors among PLWH in Guangxi, China before and after this new guideline. Methods Data from three community-based projects conducted at different time points over a period of six years (2012–2017) in Guangxi were analyzed in our study. The interviewer-administered questionnaire was used for data collection. Measures of clinical outcomes were retrieved from the patients’ medical records. Descriptive analysis was employed to display treatment patterns and the time trends of clinical outcomes. Chi-square test or ANOVA was used to compare the differences in background characteristics and treatment history between different levels of clinical outcomes. Results Among the pooled sample of 4224 participants, 77.3% were receiving antiretroviral therapy (ART), the median CD4 count was 328 cells/mm 3 , and 82.5% were virally suppressed. An increasing trend in both ART coverage (from 72.1% to 91.2%) and CD4 count (from 318 cells/mm 3 to 357 cells/mm 3 ) was observed over time in the three samples, while rates of viral suppression did not show a similar trend. A number of socio-demographic characteristics (e.g., female gender, younger age, Han ethnicity, and employment) and treatment-related variables (e.g., longer durations of HIV diagnosis and ART uptake, lower prevalence of comorbidity, fewer treatment interruptions, and more knowledge on ART) were associated with improved clinical outcomes. Conclusions We observed a high rate of viral suppression and increasing trends in ART coverage and CD4 count over six years in Guangxi, China. However, suboptimal clinical outcomes continue to be a problem, particularly among some subgroups of PLWH. Future clinical management strategies should be tailored for PLWH with different sociodemographic characteristics and treatment trajectories.

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“…Schranz et al examined how the care setting, hospital versus community-based, influences the HIV care continuum 20 . The study included patients >18 years cared for in 25 HIV clinics (12 hospital based, 13 community based) in Philadelphia from 2008–2011.…”

Section: Resultsmentioning

confidence: 99%

“…There are likely differences in the approaches to YLHIV for providers from different training backgrounds, as seen in non-HIV states such as sickle cell, cystic fibrosis, and end stage renal disease 16,17 . Further, clinics can vary in terms of location (urban versus rural, community versus academic) 18–20 . These potential provider and clinic differences may result in different outcomes among YLHIV in different settings.…”

Section: Introductionmentioning

confidence: 99%

Caring for youth living with HIV across the continuum: turning gaps into opportunities

Griffith

Agwu

2017

AIDS Care

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With the increasing proportion of youth living with human immunodeficiency virus (YLHIV) and the aging of the perinatally infected population, there is a need for clinical services that are "youth friendly" to address the multiple challenges YLHIV face in terms of engagement in care and maintenance of combination antiretroviral therapy (cART). Little is known about how and where YLHIV receive their care. Further, the impact of the care structure on engagement and retention outcomes for YLHIV is ill defined. In order to better classify how YLHIV receive care in the United States, we performed a review of published literature characterizing the structure and outcomes of care for YLHIV. Several key concepts emerged: 1. The majority of YLHIV (13-24 years old) are cared for at adult sites, 2. Clinics providing care to YLHIV are varied in terms of the services offered and the types of services offered can impact outcomes, 3. YLHIV cared for in adult clinical sites have poor retention and antiretroviral treatment initiation, and 4. YLHIV cared for at adult sites had poorer retention and cART outcomes compared to YLHIV cared for at pediatric sites. There were no studies identified that specifically examined "youth friendly" care for YLHIV within the context of adult clinical sites. The results of this review highlight disparities for YLHIV and the need for interventions to improve outcomes for YLHIV in the context of adult care.

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Comparison of HIV Outcomes for Patients Linked at Hospital Versus Community-Based Clinics

Cited by 10 publications

References 50 publications

Use of national standards to monitor HIV care and treatment in a high prevalence city—Washington, DC

Use of national standards to monitor HIV care and treatment in a high prevalence city—Washington, DC

Immunological and virologic outcomes of people living with HIV in Guangxi, China: 2012-2017

Caring for youth living with HIV across the continuum: turning gaps into opportunities

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