Human Immunodeficiency Virus (HIV) Quality Indicators Are Similar Across HIV Care Delivery Models

Rhodes, Corinne; Chang, Yuchiao; Regan, Susan; Singer, Daniel E.; Triant, Virginia A.

doi:10.1093/ofid/ofw240

Cited by 8 publications

(6 citation statements)

References 38 publications

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“…This result is not surprising since ART in Israel is given in specialized centers with qualified teams, which as reported previously improves treatment outcomes. 25…”

Section: Discussionmentioning

confidence: 99%

Continuum of HIV care of newly diagnosed individuals in Israel, 2011–2015: a population-based cohort study

et al. 2020

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Our aim was to assess the linkage to care (LTC) and treatment for people newly diagnosed with HIV in Israel during 2011–2015. The Ministry of Health estimated the annual prevalence of undiagnosed HIV; new diagnoses were identified by the Central Virology Laboratory. Only adult Israeli citizens were included. LTC at HIV centers within 90 days of diagnosis was assessed. Demographic and clinical data were collected from patient files. A total of 1538 individuals were diagnosed in 2011–2015. A moderate improvement over time was observed in the calculated proportions of undiagnosed individuals (23.1–17.3%) but no change occurred in LTC rates (82.6–81%). The proportion of diagnosed patients initiating treatment within six months increased from 54.7% in 2011 to 89.7% in 2015, with a parallel increase in the viral suppression rate from 30.5% in 2011 to 59.9% in 2015. Of 1159 patients with detailed records, 79.4% were men, median age 36 years (16–92), median CD4 cell count 342 cells/µl. Younger age, intravenous drug use, and imprisonment were independent risk factors for loss to follow-up. HIV is diagnosed late in Israel and LTC rates remain stagnated; higher awareness is still needed. Once in care, however, treatment and outcomes were in line with international standards.

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“…This result is not surprising since ART in Israel is given in specialized centers with qualified teams, which as reported previously improves treatment outcomes. 25…”

Section: Discussionmentioning

confidence: 99%

Continuum of HIV care of newly diagnosed individuals in Israel, 2011–2015: a population-based cohort study

et al. 2020

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“…This discrepancy may be due to differences in confidence related to the general care of PLWH versus care for specific non-HIV conditions as our study did not specifically ask about confidence in non-HIV care abilities. Earlier studies have shown that HIV specialists provide the majority of primary care for PLWH and patients cared for by HIV specialists have experienced better HIV associated outcomes than cared for by primary care providers [25,26].…”

Section: Discussionmentioning

confidence: 99%

“Undetectable, Now What?” HIV Provider Opinions on Barriers to Healthy Aging for Older People Living with HIV in North America

Moore¹,

Hicks²,

Benson³

et al. 2020

GGR

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Background: People living with HIV (PLWH) experience age-associated health conditions earlier than their HIV-uninfected peers and have higher rates of co-occurring conditions that impact aging. Thus, HIV providers frequently confront issues related to HIV and aging. Objective: The objective of this project was to understand provider opinions about the care of older PLWH better. Design: This was accomplished using a quantitative survey. Participants: This study involved 681 physicians treating PLWH in North America. MAIN MEASURES: We collaborated with the Emerging Infections Network (EIN) to administer a ninequestion survey covering practice characteristics, attitudes, and perceived barriers in caring for older PLWH. Key Results: Two hundred and ninety-four (43.2%) responses were collected. Providers estimate that 35% (IQR: 25-50) of their HIV-infected patients were >50 years. The majority (72%) agreed it is difficult to care for older PLWH but had confidence in their ability to do so (85%). Most list a lack of time (55.4%) and insufficient multidisciplinary support (58.5%) as limitations to the effective management of older PLWH. Multi-morbidity was overwhelmingly perceived as the most important barrier to healthy aging (62.2%) followed by tobacco/alcohol use (10%), low income/savings (8.2%), polypharmacy (4.8%) and mental illness (4.4%). Loneliness, frailty, and cognitive difficulties were judged to be less important. In conclusion, HIV providers recognized the complexity of caring for older PLWH, and yet were confident they could care for this population. Conclusion: Multi-morbidity was identified as a major barrier to healthy aging, while syndromes such as frailty and cognitive difficulties were deemed less important despite a growing body of evidence that these geriatric syndromes are common in older PLWH.

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“…A study of patients in care for HIV infection in Ontario, Canada found colorectal cancer screening was more common among patients receiving care from both generalists and specialists, compared with only HIV specialists [ 26 ]. A recent study comparing HIV care models found only minor differences in HIV quality metrics and processes of care when care was provided by generalists only, ID providers only, or both (ie, shared care) [ 27 ].…”

Section: Discussionmentioning

confidence: 99%

Should Human Immunodeficiency Virus Specialty Clinics Treat Patients With Hypertension or Refer to Primary Care? An Analysis of Treatment Outcomes

Appenheimer

Bokhour

McInnes

et al. 2017

Open Forum Infectious Diseases

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Background.Care for people with human immunodeficiency virus (HIV) increasingly focuses on comorbidities, including hypertension. Evidence indicates that antiretroviral therapy and opportunistic infections are best managed by providers experienced in HIV medicine, but it is unclear how to structure comorbidity care. Approaches include providing comorbidity care in HIV clinics (“consolidated care”) or combining HIV care with comorbidity management in primary care clinics (“shared care”). We compared blood pressure (BP) control in HIV clinics practicing consolidated care versus shared care.Methods.We created a national cohort of Veterans with HIV and hypertension receiving care in HIV clinics in Veterans Administration facilities and merged these data with a survey asking HIV providers how they delivered hypertension care (5794 Veterans in 73 clinics). We defined BP control as BP ≤140/90 mmHg on the most recent measure. We compared patients’ likelihood of experiencing BP control in clinics offering consolidated versus shared care, adjusting for patient and clinic characteristics.Results.Forty-two of 73 clinics (57.5%) practiced consolidated care for hypertension. These clinics were larger and more likely to use multidisciplinary teams. The unadjusted frequency of BP control was 65.6% in consolidated care clinics vs 59.4% in shared care clinics (P < .01). The likelihood of BP control remained higher for patients in consolidated care clinics after adjusting for patient and clinic characteristics (odds ratio, 1.32; 95% confidence interval, 1.04–1.68).Conclusions.Patients were more likely to experience BP control in clinics reporting consolidated care compared with clinics reporting shared care. For shared-care clinics, improving care coordination between HIV and primary care clinics may improve outcomes.

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Human Immunodeficiency Virus (HIV) Quality Indicators Are Similar Across HIV Care Delivery Models

Cited by 8 publications

References 38 publications

Continuum of HIV care of newly diagnosed individuals in Israel, 2011–2015: a population-based cohort study

Continuum of HIV care of newly diagnosed individuals in Israel, 2011–2015: a population-based cohort study

“Undetectable, Now What?” HIV Provider Opinions on Barriers to Healthy Aging for Older People Living with HIV in North America

Should Human Immunodeficiency Virus Specialty Clinics Treat Patients With Hypertension or Refer to Primary Care? An Analysis of Treatment Outcomes

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