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Come as You Are: Improving Care Engagement and Viral Load Suppression Among HIV Care Coordination Clients with Lower Mental Health Functioning, Unstable Housing, and Hard Drug Use

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Abstract

Lower mental health functioning, unstable housing, and drug use can complicate HIV clinical management. Merging programmatic and surveillance data, we examined characteristics and outcomes for HIV Care Coordination clients enrolled between December 2009 and March 2013. For clients diagnosed over 12 months before enrollment, we calculated post- versus pre-enrollment relative risks for short-term (12-month) care engagement and viral suppression. Both outcomes significantly improved in all subgroups, including those with lower mental health functioning, unstable housing, or hard drug use. Analyses further stratified within barrier-affected groups showed a tendency toward greater improvement when that barrier was reduced during the follow-up year.

Resumen

Un nivel más bajo de salud mental, el alojamiento inestable y el uso de drogas pueden complicar el manejo clínico del VIH. Combinamos datos programáticos y de vigilancia para examinar características y resultados de clientes del programa de Coordinación de Cuidado del VIH inscritos entre Diciembre del 2009 y Marzo del 2013. Para los clientes que fueron diagnosticados al menos doce meses antes de la inscripción, calculamos el riesgo relativo del compromiso con los cuidados y la supresión viral a corto plazo (12 meses) antes y después de la inscripción. Ambos resultados mejoraron significativamente en todos los subgrupos, incluyendo a los de nivel más bajo de salud mental, con alojamiento inestable o que usan drogas duras. Análisis adicionales estratificados entre los grupos afectados por obstáculos demostraron una tendencia hacia una mayor mejora cuando ese obstáculo fue reducido durante el siguiente año.

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Acknowledgments

The authors are indebted to Care Coordination Program providers and clients, for their invaluable and ongoing contributions to real-world program implementation and evaluation. We also thank Kent Sepkowitz, Levi Waldron, Katherine Penrose, Julie Myers, Sarah Braunstein, Bisrat Abraham, Graham Harriman, and Beau Mitts for their review of drafts and involvement in the larger intervention effectiveness study, CHORDS (Costs, Health Outcomes, and Real-world Determinants of Success in HIV Care Coordination).

Funding

This work was supported by the National Institutes of Health [Grant number R01 MH101028].

Author Contribution

Drs. Irvine and Nash conceptualized the study, along with Ms. Chamberlin. Dr. Irvine drafted the manuscript. Ms. Chamberlin, Ms. Robbins, and Ms. Robertson prepared datasets and conducted and confirmed analyses. Ms. Kulkarni assisted with preparation of the manuscript for publication. All authors participated in the interpretation of results, critically reviewed and edited the manuscript, and approved the final draft.

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Correspondence to Stephanie A. Chamberlin.

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The author declare that they have no conflict of interest.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. For this type of study formal consent is not required.

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Irvine, M.K., Chamberlin, S.A., Robbins, R.S. et al. Come as You Are: Improving Care Engagement and Viral Load Suppression Among HIV Care Coordination Clients with Lower Mental Health Functioning, Unstable Housing, and Hard Drug Use. AIDS Behav 21, 1572–1579 (2017). https://doi.org/10.1007/s10461-016-1460-4

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  • DOI: https://doi.org/10.1007/s10461-016-1460-4

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