Linkage, Engagement, and Viral Suppression Rates Among HIV-Infected Persons Receiving Care at Medical Case Management Programs in Washington, DC

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Abstract

Background:

The District of Columbia Department of Health funds facilities to provide HIV medical case management (MCM), inclusive of linkage, engagement in care, and treatment adherence support. The objective of this analysis was to identify the differences in the clinical outcomes among HIV-infected persons receiving care at MCM-funded facilities compared with those in nonfunded facilities.

Methods:

Newly diagnosed and prevalent HIV-infected persons were identified from the District of Columbia Department of Health surveillance system. Clinical outcomes of interest were linkage, retention in care, and viral suppression. Bivariate analyses and random effects logistic regression were used to examine the differences in demographics and clinical outcomes of persons receiving care at MCM-funded and nonfunded facilities.

Results:

Among 5631 prevalent cases, 56.7% received care at MCM-funded facilities of which 76.2% were retained in care, and 70.6% achieved viral suppression. Those receiving care in MCM-funded facilities were significantly more likely to be retained in care [adjusted odds ratio (aOR) 4.13; 95% confidence interval (CI): 1.93 to 8.85] and as likely (aOR 1.06; 95% CI: 0.68 to 1.62) to be virally suppressed than persons receiving care in nonfunded facilities. Among 789 newly diagnosed persons, those diagnosed in MCM-funded facilities were not significantly more likely to be linked to care within 3 months (aOR 0.50; 95% CI: 0.21 to 1.18) than those diagnosed in nonfunded facilities.

Discussion:

This study provides evidence that MCM may be beneficial to HIV-infected persons in DC by improving retention in care. Further identification of the specific services providing the most benefit to clients is needed, including a better understanding of the complex relationship between retention and viral suppression.

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