Cunningham William E, Ford Chandra L, Kinsler Janni J, Seiden Danielle, Andrews Laral, Nakazono Terry, Bell Douglas S
*Division of General Internal Medicine and Health Services Research, Department of Medicine, School of Medicine, University of California, Los Angeles, CA; Departments of †Health Policy and Management; ‡Community Health Sciences, School of Public Health, University of California, Los Angeles, CA; and §St. Mary's Medical Center, Long Beach, CA.
J Acquir Immune Defic Syndr. 2017 Jul 1;75(3):290-298. doi: 10.1097/QAI.0000000000001385.
Although antiretroviral therapy (ART) is available to treat HIV+ persons and prevent transmission, ineffective delivery of care may delay ART use, impede viral suppression (VS), and contribute to racial/ethnic disparities along the continuum of care. This study tested the effects of a bi-directional laboratory health information exchange (LHIE) intervention on each of these outcomes.
We used a quasi-experimental, interrupted time-series design to examine whether the LHIE intervention improved ART use and VS, and reduced racial/ethnic disparities in these outcomes among HIV+ patients (N = 1181) in a comprehensive HIV/AIDS clinic in Southern California. Main outcome measures were ART pharmacy fill and HIV viral load laboratory data extracted from the medical records over 3 years. Race/ethnicity and an indicator for the intervention (after vs. before) were the main predictors. The analysis involved 3-stage, multivariable logistic regression with generalized estimating equations.
Overall, the intervention predicted greater odds of ART use (odds ratio [OR] = 2.50; 95% confidence interval: 2.29 to 2.73; P < 0.001) and VS (OR = 1.12; 95% confidence interval: 1.04 to 1.21; P < 0.05) in the final models that included sociodemographic, behavioral, and clinical covariates. Before the intervention, there were significant black/white disparities in ART use OR = 0.75 (0.58-0.98; P = 0.04) and VS OR = 0.75 (0.61-0.92; P = 0.001). After the intervention, the black/white disparities decreased after adjusting for sociodemographics and the number of HIV care visits, and Latinos had greater odds than whites of ART use and VS, adjusting for covariates.
The intervention improved overall ART treatment and VS, and reduced black/white disparities. LHIE interventions may hold promise if implemented among similar patients.
尽管抗逆转录病毒疗法（ART）可用于治疗HIV感染者并预防传播，但医疗服务提供无效可能会延迟ART的使用，阻碍病毒抑制（VS），并导致在连续医疗过程中的种族/族裔差异。本研究测试了双向实验室健康信息交换（LHIE）干预对这些结果的影响。
我们采用了准实验性中断时间序列设计，以检验LHIE干预是否改善了ART的使用和VS，并减少了南加州一家综合性HIV/AIDS诊所中HIV感染者（N = 1181）在这些结果方面的种族/族裔差异。主要结局指标是从3年医疗记录中提取的ART药房配药情况和HIV病毒载量实验室数据。种族/族裔以及干预指标（干预后与干预前）是主要预测因素。分析采用了三阶段多变量逻辑回归和广义估计方程。
总体而言，在纳入社会人口统计学、行为学和临床协变量的最终模型中，干预预测了更高的ART使用几率（优势比[OR] = 2.50；95%置信区间：2.29至2.73；P < 0.001）和VS几率（OR = 1.12；95%置信区间：1.04至1.21；P < 0.05）。在干预前，ART使用方面存在显著的黑/白差异（OR = 0.75 [0.58 - 0.98]；P = 0.04），VS方面也存在差异（OR = 0.75 [0.61 - 0.92]；P = 0.001）。干预后，在调整社会人口统计学和HIV护理就诊次数后，黑/白差异减小，并且在调整协变量后，拉丁裔使用ART和实现VS的几率高于白人。
该干预改善了总体ART治疗和VS，并减少了黑/白差异。如果在类似患者中实施，LHIE干预可能具有前景。
