1 Louisiana Department of Health, STD/HIV Program, Office of Public Health, New Orleans, LA, USA.
Public Health Rep. 2018 Nov/Dec;133(2_suppl):75S-86S. doi: 10.1177/0033354918793096.
The Care and Prevention in the United States Demonstration Project aimed to reduce HIV/AIDS-related morbidity and mortality among racial/ethnic minority groups in 8 states. We evaluated Health Models, a pay-for-performance program piloted by the Louisiana Department of Health that used financial incentives to improve rates of engagement in HIV medical care and viral suppression among people with HIV.
We enrolled 2076 patients of 3 urban HIV specialty clinics in Louisiana in the Health Models pay-for-performance program on a rolling basis from September 2013 through September 2016 and gave patients cash incentives to attend HIV medical appointments, achieve or maintain viral suppression, and link to supportive services. We used laboratory data collected from Louisiana's HIV surveillance database to calculate rates of engagement in care and viral suppression during the first 24 months of enrollment.
Of the 2076 patients who enrolled, 1400 (67.4%) were non-Hispanic black, 1480 (71.3%) were male, 1175 (56.6%) were men who have sex with men, and 1371 (66.0%) reported an annual income of <$15 000. At enrollment, 1456 (70.1%) patients were engaged in HIV care, and 1197 (57.7%) patients were virally suppressed. After 12 months of enrollment, 1474 of 1783 (82.7%) patients were virally suppressed. Of enrolled patients with at least 12 or 24 months of follow-up data, 1299 of 1317 (98.6%) patients were engaged in care during their first 12 months of enrollment, and 995 of 1033 (96.3%) patients were engaged in care between 12 and 24 months of enrollment.
During the implementation of Health Models, enrolled patients had increases in rates of viral suppression and achieved rates of engagement in care and viral suppression that were higher than national levels; however, additional supportive services may be needed to further reduce socioeconomic disparities in the rates of viral suppression.
“美国护理与预防示范项目”旨在降低 8 个州中少数族裔群体的艾滋病相关发病率和死亡率。我们评估了健康模型，这是路易斯安那州卫生部门试点的一项按效付费计划，该计划通过经济奖励来提高艾滋病毒感染者接受艾滋病毒医疗护理和病毒抑制的比例。
我们从 2013 年 9 月到 2016 年 9 月，在路易斯安那州的 3 家城市艾滋病毒专科诊所，按滚动原则纳入了 2076 名患者参加健康模型按效付费项目，并向患者提供现金奖励，以促使他们参加艾滋病毒医疗预约、实现或维持病毒抑制，并与支持性服务建立联系。我们利用从路易斯安那州艾滋病毒监测数据库收集的实验室数据，计算了入组后 24 个月内参与护理和病毒抑制的比例。
在 2076 名入组患者中，1400 名（67.4%）是非西班牙裔黑人，1480 名（71.3%）是男性，1175 名（56.6%）是男男性行为者，1371 名（66.0%）报告年收入<15000 美元。入组时，1456 名（70.1%）患者接受艾滋病毒护理，1197 名（57.7%）患者病毒得到抑制。入组后 12 个月，1783 名患者中有 1474 名（82.7%）病毒得到抑制。在至少有 12 个月或 24 个月随访数据的入组患者中，1317 名患者中有 1299 名（98.6%）在入组后的第 12 个月接受护理，1033 名患者中有 995 名（96.3%）在 12 至 24 个月的随访期间接受护理。
在健康模型的实施过程中，入组患者的病毒抑制率有所提高，达到了参与护理和病毒抑制的比例，高于全国水平；然而，可能需要额外的支持性服务，以进一步减少病毒抑制率方面的社会经济差异。
