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

  • Julia D. LópezEmail author
  • Enbal Shacham
  • Tawnya Brown
Original Paper


Clinic appointment attendance is a significant determinant of improved HIV health outcomes. A retrospective longitudinal analysis from 2009 to 2015 examined the relationship of clinic policy attendance with and without medical case management (MCM) on HIV clinical outcomes. Clinical parameters were abstracted across the study years and latent growth models measured HIV clinical outcomes as a function of time. A total of 2773 patients were included in this study. More than the majority of individuals had 75% clinic policy attendance during each of the study years and the median number of MCM contact visits with the case manager was 4.0 visits per year (p < 0.01). While the overall trend identified improved HIV clinical outcomes across the clinic population over the study period, it also revealed individuals receiving MCM and with 75% clinic policy attendance had significantly faster improvement in HIV clinical outcomes compared to the individuals who did not receive MCM nor had 75% clinic policy attendance. This study identified how MCM, in combination with clinic policy attendance efforts, are useful in quickly improving HIV viral load and CD4 T-cell count. These findings support the continued need for funding of the Ryan White Care Act as it assists with the support of MCM and appointment attendance through the guidance of wrap-around services.


HIV/AIDS Medical case management Clinic policy attendance HIV management Retrospective longitudinal study Latent growth modeling 


La asistencia a citas en la clínica es un determinante significativo de la mejora de los resultados de salud del VIH. Un análisis longitudinal retrospectivo de 2009 a 2015 examinó la relación de la asistencia a las políticas clínicas con y sin gestión de casos médicos (MCM) sobre los resultados clínicos del VIH. Los parámetros clínicos se abstrajeron a lo largo de los años de estudio y los modelos de crecimiento latentes midieron los resultados clínicos del VIH en función del tiempo. Un total de 2773 pacientes fueron incluidos en este estudio. Más de la mayoría de las personas tuvieron un 75% de asistencia a políticas clínicas durante cada uno de los años de estudio y la mediana del número de visitas de contacto de MCM con el administrador del caso fue de 4.0 visitas por año (p < 0.01). Si bien la tendencia general identificó mejores resultados clínicos del VIH en toda la población clínica durante el período de estudio, también reveló que las personas que recibieron MCM y con una asistencia a políticas clínicas del 75% tuvieron una mejora significativamente más rápida en los resultados clínicos del VIH en comparación con las personas que no recibieron MCM ni tuvieron 75% de asistencia a la política clínica. Este estudio identificó cómo MCM, en combinación con los esfuerzos de asistencia a políticas clínicas, son útiles para mejorar rápidamente la carga viral del VIH y el recuento de células T CD4. Estos hallazgos apoyan la necesidad continua de financiación de la Ryan White VIH/SIDA programa, ya que ayuda con el apoyo de MCM y la asistencia a citas a través de la guía de los administradores de casos de VIH.

Palabras clave

VIH/SIDA Administración de casos médicos Asistencia a políticas clínicas Estudio longitudinal retrospectivo Modelos de crecimiento latente 


Compliance with Ethical Standards

Conflict of interest

The authors declare no conflicts of interest.

Ethical Approval

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.

Informed Consent

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


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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of Obstetrics and GynecologyWashington University School of MedicineSaint LouisUSA
  2. 2.Department of Behavioral Sciences and Health Education, College for Public Health and Social JusticeSaint Louis UniversitySaint LouisUSA
  3. 3.Infectious Diseases ClinicWashington University School of MedicineSaint LouisUSA

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