Reducing Disparities: A Virtual Quality Improvement Collaborative Resulted in Better Health Outcomes for 4 Target Populations Disproportionately Affected by HIV

Abstract

Context: Although viral suppression rates have recently increased among people with HIV, specific populations still experience disparities in health outcomes, a priority in the national response to end the HIV epidemic. Purpose: The end+disparities ECHO Collaborative, a quality improvement initiative among HIV providers in the United States from June 2018 to December 2019, created virtual communities of practice to measurably increase viral suppression rates in populations disproportionately affected by HIV: men who have sex with men of color, Black/African American and Latina women, youth aged 13 to 24 years, and transgender people. Methods: Participating Ryan White HIV/AIDS Program-funded providers prioritized their improvement efforts to focus on one target population and joined virtual affinity sessions with other providers focused on that population for guidance by subject matter experts and exchanges with peer providers. During 9 submission cycles, providers reported their viral suppression data for the preceding 12 months. Main Outcome Measures: The principal outcome measures were changes in viral suppression rates among 4 target populations and changes in viral suppression gaps compared with the rest of HIV-infected patients served by the same agency. Results: A total of 90 providers were included in the data analyses with an average of 110 775 reported patients, out of which 19 442 represented the targeted populations. The average viral suppression rates for agency-selected populations increased from 79.2% to 82.3% (a 3.9% increase), while the remaining caseload increased at a lower rate from 84.9% to 86.1% (a 1.4% increase). The viral suppression gap was reduced from 5.7% to 3.8%, a 33.5% reduction. Improvements were found across all target populations. Conclusions: The collaborative demonstrated improved health outcomes and reductions in HIV-related health disparities, moving toward ending the HIV epidemic. The model of utilizing low-cost videoconferencing technologies to create virtual communities of learning is well suited to mitigate other disease-related disparities, nationally and abroad.

Internet-based peer support interventions for people living with HIV: A scoping review

“…The majority of articled revised were studies conducted in the United States (12) [ 77 , 80 – 82 , 84 , 88 , 90 , 94 , 95 , 99 , 100 , 104 ], three were from Kenya [ 86 , 92 , 102 ] and three from South Africa [ 85 , 93 , 101 ]. Locations like China, the United Kingdom and Zambia had two studies included in this review [ 79 , 87 , 91 , 96 , 98 , 103 ] and, from the total of articles included, only one article was from Malaysia, Nigeria, Tanzania and Uganda [ 78 , 83 , 89 , 97 ].…”

“…Regarding the study type, eight of the included articles corresponded to pilot studies [ 77 , 79 , 86 , 88 , 92 , 101 , 102 , 104 ], while seven articles explicitly indicate a clinical trial type of design [ 83 , 85 , 86 , 90 , 95 , 96 , 98 ], as well as five protocols [ 80 – 82 , 93 , 94 ] and five qualitative studies [ 87 , 91 , 99 , 100 , 103 ]. Only two Randomized Controlled Trials [ 78 , 97 ], and one cohort study [ 89 ].…”

“…All the interventions were exclusively conducted for PLWHA. Of the total of interventions reviewed, 10 of them were orientated to an adult population (18 years or older) [ 77 , 78 , 88 , 94 , 95 , 98 , 99 , 102 – 104 ], nine were tailored for children, adolescents, and young adults [ 79 – 81 , 84 – 86 , 90 , 97 , 101 ], three interventions were exclusively designed for adolescents [ 83 , 93 , 96 ], and only one was made exclusive for young adults [ 100 ]. Finally, four interventions were orientated to other populations (e.g., mothers, female sex workers, men who have sex with other men [MSM]) [ 82 , 87 , 89 , 91 ].…”

“…The development of a smartphone App was also present in 4 interventions [ 77 , 88 , 96 , 99 ], along with the use of SMS and phone calls to establish communication between peers [ 78 , 81 , 85 , 93 ]. Only three studies developed a web-based platform [ 84 , 94 , 95 ], two used SMS communication exclusively [ 87 , 97 ], and two interventions were delivered via videoconference [ 90 , 98 ]. Only one intervention showed the participants´ videos made by peers [ 104 ].…”

“…The most common objectives were treatment adherence (n = 14) [ 78 , 80 , 82 – 86 , 88 , 89 , 92 , 95 , 99 , 102 , 104 ], and social support (n = 7) [ 77 , 83 , 91 , 94 , 96 , 101 , 103 ]. Five of the interventions were dedicated to retention in care [ 87 , 88 , 93 , 95 , 101 ], and four to viral load suppression [ 78 , 80 , 90 , 95 ]. Two interventions were oriented to stigma reduction [ 92 , 104 ] and the other two to increase HIV knowledge [ 83 , 98 ].…”