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The Impact of the Ryan White HIV/AIDS Medical Case Management Program on HIV Clinical Outcomes: A Longitudinal Study

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Abstract

Medical case management (MCM) is a core medical service in The Ryan White HIV/AIDS Program and aims to provide treatment and care for people living with HIV/AIDS by engaging, identifying and eliminating barriers to HIV care. Little research has examined the impact of this intervention; therefore, the purpose of this study was to examine the how MCM affects HIV clinical outcomes. The study took place at a midwestern, outpatient infectious diseases clinic. This study utilized a longitudinal, retrospective study design to analyze to the impact of MCM engagement on HIV clinical outcomes (viral loads, CD4 counts) from 2009 to 2015 as a time-varying predictor. A total of 2773 patients were included in this study, of which 975 patients (35.2%) engaged in MCM. Among those in MCM, approximately 90% of the population were between 25 and 64 years of age, more than three-quarters were African American men, mean time of HIV care engagement in at this clinic care was 3.2 (± 4.1), while mean years living with HIV was 10.5 (± 7.1). Throughout the study period, those engaged in MCM had a significantly faster improvement in their HIV clinical outcomes compared to the non-MCM group (p < 0.001). The study highlights the significant impact MCM services have on improving CD4 T cell counts and HIV viral loads. The successful care coordination that MCM offers clearly improves health outcomes while creating a network of patient care.

Resumen

Administración de casos médicos (MCM) es un núcleo de servicio médico en la Ryan White VIH/SIDA programa y su objetivo es proveer tratamiento y cuidado de las personas que viven con VIH/SIDA por participar, identificar y eliminar barreras para el cuidado del VIH. Poca investigación ha examinado el impacto de esta intervención; por lo tanto, el propósito de este estudio era examinar cómo MCM afecta los resultados clínicos del VIH. El estudio tuvo lugar en una medio oeste, en una clínica de enfermedades infecciosas de pacientes ambulatorios. Este estudio utilizó un diseño del estudio longitudinal, retrospectivo para analizar el impacto del compromiso de MCM en los resultados clínicos de VIH (carga viral, recuentos de CD4) desde 2009 hasta 2015 como un predictor de variables en el tiempo. Un total de 2.773 pacientes se incluyeron en este estudio, de los cuales 975 pacientes (35.2%) a MCM. Entre los MCM, aproximadamente el 90% de la población entre 25 y 64 años de edad, más de tres cuartas partes eran hombres afroamericanos, tiempo medio de compromiso de atención de VIH en esta atención clínica 3.2 (± 4.1), mientras que el promedio de años que viven con VIH fue 10.5 (± 7.1). Durante el período de estudio, quienes se dedican a MCM tuvieron una mejoría significativamente más rápida en sus resultados clínicos de VIH en comparación con el grupo no-MCM (p < 0001). Los aspectos más destacados fuel el impacto de los servicios MCM en mejorando los recuentos CD4 y carga viral de VIH. La coordinación de la atención acertada que MCM ofrece mejora claramente los resultados de salud, creando una red de atención de los pacientes.

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Acknowledgements

We would like to thank the patients and staff at the Washington University Infectious Diseases Clinic. The authors would also like to acknowledge Jessica Grubb, M.D., Hong Xian, Ph.D., and Jeremy Green, Ph.D. for their consultation in this work.

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Authors and Affiliations

  1. Department of Behavioral Sciences and Health Education, College for Public Health and Social Justice, Saint Louis University, 3545 Lafayette Avenue, Saint Louis, MO, 63104, USA

    Julia D. López & Enbal Shacham

  2. Washington University School of Medicine, Infectious Diseases Clinic, 620 South Taylor Avenue, Saint Louis, MO, 63110, USA

    Tawnya Brown

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  1. Julia D. López
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  2. Enbal Shacham
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  3. Tawnya Brown
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Correspondence to Julia D. López.

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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.

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Informed consent was obtained from all individual participants included in the study.

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López, J.D., Shacham, E. & Brown, T. The Impact of the Ryan White HIV/AIDS Medical Case Management Program on HIV Clinical Outcomes: A Longitudinal Study. AIDS Behav 22, 3091–3099 (2018). https://doi.org/10.1007/s10461-018-2124-3

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  • DOI: https://doi.org/10.1007/s10461-018-2124-3

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