142nd APHA Annual Meeting and Exposition

Annual Meeting Recordings are now available for purchase

305573
Robust short-term effectiveness of a comprehensive HIV care coordination program in New York City (NYC)

142nd APHA Annual Meeting and Exposition (November 15 - November 19, 2014): http://www.apha.org/events-and-meetings/annual
Sunday, November 16, 2014

Mary Irvine, DrPH , Bureau of HIV/AIDS Prevention & Control, New York City Department of Health and Mental Hygiene, Queens, NY
Stephanie Chamberlin, MPH, MIA , Bureau of HIV/AIDS Prevention and Control, New York City Department of Health and Mental Hygeine, Long Island City, NY
Rebekkah Robbins, MPH
Julie Myers, MD, MPH , Department of Medicine, Division of Infectious Diseases, Columbia University Medical Center, New York
Graham Harriman, MA , Bureau of HIV/AIDS, Care and Treatment, New York City Department of Health and Mental Hygiene, Long Island City, NY
Sarah Braunstein, PhD MPH , HIV/AIDS Epidemiology and Field Services, New York City Department of Health and Mental Hygiene, Long Island City, NY
Beau J. Mitts, MPH , Bureau of HIV/AIDS Prevention and Control , Care and Treatment Program, Ney York City Department of Health and Mental Hygiene, Queens, NY, NY
Sarah Gorrell-Kulkarni, MPH
Denis Nash, PhD , CUNY School of Public Health, Hunter College, New York, NY
Background:

Evidence is needed regarding HIV interventions improving engagement in care (EiC) and viral load suppression (VLS). We assessed subgroup differences in EiC and VLS change following enrollment into a comprehensive medical case management intervention, the NYC Ryan White HIV Care Coordination Program (CCP).

 Methods:

Using local program and laboratory records from surveillance, we examined pre- and post-enrollment outcomes for 3,176 clients enrolled before April 2011 and diagnosed >1 year before enrollment in CCP at 28 agencies. For the year before and after enrollment, we estimated EiC (≥2 tests ≥90 days apart, ≥1 in each half-year) and VLS (VL ≤200 copies/mL on latest test in the second half of the year). Relative risks (RRs) and confidence intervals (CIs) for the outcomes were estimated using generalized estimating equations.

 Results:

The proportions with EiC and VLS increased from 74% to 91% (RREiC=1.24, 95% CI: 1.21-1.27) and from 32% to 51% (RRVLS=1.58, 95% CI: 1.50-1.66). Significant improvements held across subgroups, except clients with baseline CD4 ≥500 (VLS only) or “other/unknown” race (EiC only). The greatest improvements were among those who were age < 45, diagnosed >2004, not prescribed antiretrovirals, male (EiC only), making <$9,000/year (EiC only), uninsured (EiC only), homeless (EiC only), unsuppressed (EiC only), and CD4 <200 (VLS only) at enrollment. Significant improvements were observed for EiC at 25 (89%) and VLS at 21 (75%) of 28 agencies.

 Conclusions:

EiC and VLS improvements were robust across most subgroups.  Differences found suggest the value of targeting recruitment to those with evident care/treatment barriers.

Learning Areas:

Epidemiology
Public health or related education

Learning Objectives:
Demonstrate sub-group differences in care engagement and viral load suppression among participants in a comprehensive HIV care coordination program.

Keyword(s): Adherence, HIV/AIDS

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I have over eight years of program evaluation experience directly related to social policy, specifically the delivery of health services to under-served populations. I have worked in various capacities across 15 countries to enhance monitoring and evaluation efforts and the development of programs targeting complex social issues, including HIV prevention and treatment programs. I received my Master of Public Health and Mater of International Affairs degrees from Columbia University.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.

Back to: 2032.0: HIV/AIDS Care