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.
J Acquir Immune Defic Syndr. 2019 Jan 1;80(1):46-55. doi: 10.1097/QAI.0000000000001877.
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.
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.
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).
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.
评估一项强化和综合的 Ryan White Part A 资助的艾滋病毒护理协调计划的长期效果，该计划招募艾滋病毒感染者，这些感染者有过艾滋病毒护理结果不理想的历史。
我们将 CCP 客户的项目数据与所有成年艾滋病毒感染者的监测数据合并。使用倾向评分匹配，我们确定了一个同期的、未接受 CCP 暴露的对照组。持久病毒抑制（DVS）定义为定期病毒载量（VL）监测和随访 13-36 个月内所有 VLs ≤200 拷贝/毫升。
联合队列的 90%（N=12414）在随访期间（2009 年 12 月 1 日至 2016 年 3 月 31 日）有≥1 次 VLs ≤200，并且几乎所有人都有常规 VL 监测，但只有 36.8%的人有 DVS。尽管总体上 DVS 没有差异（相对风险：0.99，95%置信区间：0.95 至 1.03），但在注册前 12 个月没有任何 VL 抑制（VLS）的 CCP 客户与“常规护理”接受者相比，DVS 更高（21.3%比 18.4%；相对风险：1.16，95%置信区间：1.04 至 1.29）。
在 CCP 注册前未抑制的患者中，参加强化干预措施可适度提高 DVS。如果将没有 VLS 证据的人优先纳入 CCP 注册，而不是将最近有 VLS 证据的人纳入 CCP 注册，那么该计划有望实现治疗即预防目标，并推进艾滋病毒护理连续体的进展。总体 DVS 水平低（<40%）强调需要在高治疗可及性的背景下，重点进行坚持治疗的维持干预。
