Community-based HIV primary care in the Bronx: Patient characteristics and treatment outcomes

Background: Community-based HIV services may help reduce health disparities by facilitating earlier diagnosis and treatment of HIV/AIDS. We describe patients and HAART outcomes in our network of academically-affiliated, community-based clinics offering HIV services in the Bronx, NY.

Methods: Retrospective cohort study of HIV-positive adults in a large primary care network; data were collected from standardized chart review. Chi-square, t-tests, and multivariate regression were used.

Results: 423 HIV-infected adults initiated care from 1/05-12/07. Mean age was 43.7 years, 57% were male, 85.1% African-American or Latino, and 63% acquired HIV sexually. Median duration of known infection was 9 years. 46% presented with AIDS (vs. 59% of patients at our hospital-based specialty center, p < 0.01). Median initial CD4 count was 392 cells/mm3. 22% were recently diagnosed; these patients were 1.8x likelier to present with AIDS (vs. patients with chronic infection [95% CI 1.10-2.88], p = 0.02).

Of 178 subjects starting HAART, 66% achieved viral suppression in 16-32 weeks (vs. 62% at the specialty center, p = 0.41). Patients with ≥ 95% HAART adherence were 3.1x likelier to achieve viral suppression (vs. patients with unknown/< 95% adherence [95% CI 2.24-3.95], p < 0.01).

Conclusions: This predominantly minority population of HIV-infected patients received effective HIV care in community-based, primary care settings. Although individuals present to community-based clinics (vs. hospital settings) with less advanced disease, patients with recent diagnoses are likelier to present with AIDS. This underscores the need for expanded testing, earlier diagnosis, and HIV-focused services to engage individuals in ongoing care.