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Impact of an HIV Care Coordination Program on Durable Viral Suppression

Robertson, McKaylee M., MPH*,†; Penrose, Kate, MS; Irvine, Mary K., DrPH, MPH; Robbins, Rebekkah S., MPH; Kulkarni, Sarah, MPH*,†; Braunstein, Sarah L., PhD, MPH; Waldron, Levi, PhD*,†; Harriman, Graham, MA; Nash, Denis, PhD, MPH*,†

JAIDS Journal of Acquired Immune Deficiency Syndromes: January 1, 2019 - Volume 80 - Issue 1 - p 46–55
doi: 10.1097/QAI.0000000000001877
Implementation Science
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Background: To assess long-term effectiveness of an intensive and comprehensive Ryan White Part A-funded HIV Care Coordination Program recruiting people living with HIV with a history of suboptimal HIV care outcomes.

Methods: We merged programmatic data on CCP clients with surveillance data on all adults diagnosed with HIV. Using propensity score matching, we identified a contemporaneous, non–CCP-exposed comparison group. Durable viral suppression (DVS) was defined as regular viral load (VL) monitoring and all VLs ≤200 copies per milliliter in months 13–36 of follow-up.

Results: Ninety percent of the combined cohort (N = 12,414) had ≥1 VL ≤200 during the follow-up period (December 1, 2009–March 31, 2016), and nearly all had routine VL monitoring, but only 36.8% had DVS. Although DVS did not differ overall (relative risk: 0.99, 95% confidence interval: 0.95 to 1.03), CCP clients without any VL suppression (VLS) in the 12-month pre-enrollment showed higher DVS versus “usual care” recipients (21.3% versus 18.4%; relative risk: 1.16, 95% confidence interval: 1.04 to 1.29).

Conclusions: Enrollment in an intensive intervention modestly improved DVS among those unsuppressed before CCP enrollment. This program shows promise for meeting treatment-as-prevention goals and advancing progress along the HIV care continuum, if people without evidence of VLS are prioritized for CCP enrollment over those with recent evidence of VLS. Low overall DVS (<40%) levels underscore a need for focused adherence maintenance interventions, in a context of high treatment access.

*Institute for Implementation Science in Population Health (ISPH), City University of New York (CUNY), New York City, New York

Graduate School of Public Health and Health Policy, City University of New York (CUNY), New York City, New York

New York City Department of Health and Mental Hygiene, Bureau of HIV/AIDS Prevention and Control, New York City, New York

Correspondence to: McKaylee M. Robertson, MPH, Institute for Implementation Science in Population Health, Graduate School of Public Health and Health Policy, City University of New York, 55 W. 125th Street, New York, NY 10027 (e-mail: mckaylee.robertson@sph.cuny.edu).

Supported by the National Institute of Mental Health of the National Institutes of Health (grant number R01 MH101028 to D.N. and M.K.I.). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

Presented in part at the 12th International Conference on HIV Treatment and Prevention Adherence; June 4–6, 2017; Miami, FL.

The authors have no funding or conflicts of interest to disclose.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's Web site (www.jaids.com).

Received May 16, 2018

Accepted September 13, 2018

Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.