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

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% (RR_EiC=1.24, 95% CI: 1.21-1.27) and from 32% to 51% (RR_VLS=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.