Background
Although antiretroviral therapy (ART) is available to treat
HIV+ persons and prevent transmission, ineffective delivery of care
may delay ART use, impede viral suppression (VS) and contribute to
racial/ethnic disparities along the continuum of care. This study tested the
effects of a bi-directional laboratory health information exchange (LHIE)
intervention on each of these outcomes.
Methods
We used a quasi-experimental, interrupted time series design to
examine whether the LHIE intervention improved ART use and VS, and reduced
racial/ethnic disparities in these outcomes among HIV+ patients
(N=1,181) in a comprehensive HIV/AIDS clinic in Southern California.
Main outcome measures included ART pharmacy fill and HIV VL lab data
extracted from the medical records over three years. Race/ethnicity and an
indicator for the intervention (after vs. before) were the main predictors.
The analysis involved three-stage, multivariable logistic regression with
generalized estimating equations (GEE).
Results
Overall, the intervention predicted greater odds of ART use
(OR=2.50; 95% CI=2.29-2.73; P<0.001) and VS
(OR=1.12; 95% CI=1.04-1.21; P<0.05) in the
final models that included sociodemographic, behavioral, and clinical
covariates. Prior to the intervention, there were significant Black/White
disparities in ART use OR=0.75 (0.58-0.98; P=0.04) and VS
OR=0.75 (0.61-0.92; P=0.001). After the intervention, the
Black/White disparities decreased after adjusting for sociodemographics and
the number of HIV care visits, and Latinos had greater odds than Whites of
ART use and VS, adjusting for covariates.
Conclusions
The intervention improved overall ART treatment and VS, and reduced
Black/White disparities. LHIE interventions may hold promise if implemented
among similar patients.