Organization of care for persons with HIV-infection: a systematic review

Abstract

The objective of this systematic review was to examine the effectiveness of the organization of care: case management, multidisciplinary care, multi-faceted treatment, hours of service, outreach programs and health information systems on medical, immunological, virological, psychosocial and economic outcomes for persons living with HIV/AIDS. We searched PubMed (MEDLINE) and 10 other electronic databases from 1 January 1980 to April, 2012 for both experimental and controlled observational studies. Thirty-three studies met the inclusion criteria. Eleven studies were randomized controlled trials (RCTs), three of which were conducted in low-middle income settings. Patient characteristics, study design, organization measures and outcomes data were abstracted independently by two reviewers from all studies. A risk of bias tool was applied to RCTs and a separate tool was used to assess the quality of observational studies. This review concludes that case management interventions were most consistently associated with improvements in immunological outcomes but case management demonstrates no clear association with other outcome measures. The same mixed results were also identified for multidisciplinary and multi-faceted care interventions. Eight studies with an outreach intervention were identified and demonstrated improvements or non-inferiority with respect to mortality, receipt of antiretroviral medications, immunological outcomes, improvements in healthcare utilization and lower reported healthcare costs when compared to usual care. Of the interventions examined in this review, sustained in-person case management and outreach interventions were most consistently associated with improved medical and economic outcomes, in particular antiretroviral prescribing, immunological outcomes and healthcare utilization. No firm conclusions can be reached about the impact of any one intervention on patient mortality.

Understanding geriatric models of care for older adults living with HIV: A Scoping Review and Qualitative Analysis

“…Multidisciplinary providers who work in team-based care models have been shown to improve clinical outcomes among HIV patients [70][71][72][73] . This study provided examples of collaborations in which practitioners worked together to meet the diverse needs of patients.…”

Comparing neighborhood and state contexts for women living with and without HIV: understanding the Southern HIV epidemic

“…One ecological study showed that in low income areas, car ownership was associated with a higher proportion of individuals linked to care, and high access to public transportation was associated with a higher proportion of patients with suppressed HIV viral load (Goswami et al, 2016). When people live in areas of lower population density and HIV services are far away, the solutions to transportation barriers are not easy; mobile health clinics (Garrett, 1995; Kahn, Moseley, Thilges, Johnson, & Farley, 2003) and case management (Handford, Tynan, Agha, Rzeznikiewiz, & Glazier, 2016) can be effective methods of increasing retention in care and improving HIV outcomes.…”