Non-Communicable Disease Preventive Screening by HIV Care Model

Abstract

ImportanceThe Human Immunodeficiency Virus (HIV) epidemic has evolved, with an increasing non-communicable disease (NCD) burden emerging and need for long-term management, yet there are limited data to help delineate the optimal care model to screen for NCDs for this patient population.ObjectiveThe primary aim was to compare rates of NCD preventive screening in persons living with HIV/AIDS (PLWHA) by type of HIV care model, focusing on metabolic/cardiovascular disease (CVD) and cancer screening. We hypothesized that primary care models that included generalists would have higher preventive screening rates.DesignProspective observational cohort study.SettingPartners HealthCare System (PHS) encompassing Brigham & Women’s Hospital, Massachusetts General Hospital, and affiliated community health centers.ParticipantsPLWHA age >18 engaged in active primary care at PHS.ExposureHIV care model categorized as infectious disease (ID) providers only, generalist providers only, or ID plus generalist providers.Main Outcome(s) and Measures(s)Odds of screening for metabolic/CVD outcomes including hypertension (HTN), obesity, hyperlipidemia (HL), and diabetes (DM) and cancer including colorectal cancer (CRC), cervical cancer, and breast cancer.ResultsIn a cohort of 1565 PLWHA, distribution by HIV care model was 875 ID (56%), 90 generalists (6%), and 600 ID plus generalists (38%). Patients in the generalist group had lower odds of viral suppression but similar CD4 counts and ART exposure as compared with ID and ID plus generalist groups. In analyses adjusting for sociodemographic and clinical covariates and clustering within provider, there were no significant differences in metabolic/CVD or cancer screening rates among the three HIV care models.ConclusionsThere were no notable differences in metabolic/CVD or cancer screening rates by HIV care model after adjusting for sociodemographic and clinical factors. These findings suggest that HIV patients receive similar preventive health care for NCDs independent of HIV care model.

Understanding constraints on integrated care for people with HIV and multimorbid cardiovascular conditions: an application of the Theoretical Domains Framework

“…In the USA, there are limited evaluations of HIV clinics that integrate multiple CVD preventive services [ 26 ]. The few examples [ 27 – 29 ] do not address the full cache of conditions needed for comprehensive CVD prevention and present mixed findings when comparing outcomes to shared care or consolidated care models. Additional study is needed to determine how successful integrated care models can be expanded to address all of the CVD prevention needs of PWH [ 24 ].…”

Multimorbidity Among Persons Living with Human Immunodeficiency Virus in the United States

“…However, there is an absence of formal multimorbidity care guidelines [32]. Literature evaluating optimal care models suggests that primary care providers, infectious disease providers, or the partnership of both, are equally effective at screening for age-associated conditions [33]. However, comfort levels varied for the treatment of conditions such as HTN [34].…”

Integrated management of HIV/NCDs: knowledge, attitudes, and practices of health care workers in Gaborone, Botswana

“…Our findings are different to those identified in a study among HIV patients accessing primary care from Partners in Health, where no differences were observed in screening rates for metabolic, cardiovascular diseases as well as cancer rates regardless of HIV care model. 22 . Following a successful integration of HIV and TB, the Botswana Government is reviewing the essential primary care package to factor in the NCD epidemic and provide comprehensive management of HIV and other chronic diseases.…”