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Improvements in Retention in Care and HIV Viral Suppression Among Persons with HIV and Comorbid Mental Health Conditions: Patient-Centered HIV Care Model

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Abstract

The Patient-centered HIV Care Model (PCHCM) integrated community-based pharmacists with medical providers and required sharing of patient clinical information and collaborative therapy-related action planning. We determined the proportions of participants with HIV and mental health conditions who were retained in care and the proportion virally suppressed, pre- and post-implementation. Overall, we found a relative 13% improvement in both retention [60% to 68% (p = 0.009)] and viral suppression [79% to 90% (p < 0.001)]. Notable improvements were seen among persons triply diagnosed with HIV, mental illness and substance use [+ 36% (50% to 68%, p = 0.036) and + 32% (66% to 86%, p = 0.001) in retention and viral suppression, respectively]. There were no differences in the proportions of persons adherent to psychiatric medications, pre- to post-implementation, nor were there differences in the proportions of persons retained in care or virally suppressed by psychiatric medication adherence, post-implementation. PCHCM demonstrated that collaborations between community-based pharmacists and medical providers can improve HIV care continuum outcomes among persons with mental health conditions.

Resumen

El modelo de atención para el VIH centrada en el paciente (PCHCM) integró a farmacéuticos de la comunidad y a proveedores médicos, y requirió compartir la información clínica del paciente y planificar medidas colaborativas relacionadas con la terapia. Determinamos las proporciones de participantes con VIH y afecciones de salud mental que permanecieron bajo atención médica y la proporción de quienes habían logrado la supresión viral, antes y después de la implementación. En líneas generales, hallamos una mejoría relativa del 13% tanto en la permanencia bajo atención médica (60% a 68% [p = 0.009]) como en la supresión viral (79% a 90% [p < 0.001]). Se observaron mejorías notables entre personas con diagnóstico triple de VIH, enfermedad mental y consumo de sustancias (+ 36% [50% a 68%, p=0.036] y +32 % [66% a 86%, p = 0.001] en la permanencia bajo atención médica y la supresión viral, respectivamente). No hubo diferencias en las proporciones de personas con adhesión a los medicamentos siquiátricos, desde antes hasta después de la implementación, ni tampoco diferencias en la proporción de personas que permanecieron bajo atención médica o con supresión viral por su adhesión a los medicamentos siquiátricos, después de la implementación. El PCHCM demostró que las colaboraciones entre los farmacéuticos de la comunidad y los proveedores médicos pueden mejorar los resultados del proceso continuo de atención para el VIH entre personas con afecciones de salud mental.

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Acknowledgements

This work was supported by the Secretary’s Minority AIDS Initiative Fund and the Centers for Disease Control and Prevention through a Co-operative Agreement (Grant Number NU65PS004275) with the University of North Texas Health Science Center System College of Pharmacy. Walgreens Co. provided all pharmacist services in-kind. Patient-centered HIV Care Model Team Michael Aguirre, Osayi Akinbosoye, David M. Bamberger, Ben Bluml, Katura Bullock, Diane C. Burrell, Tim Bush, Clifton Bush, Kathy K. Byrd (Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, 1600 Clifton Rd., MS US8-4, Atlanta, GA, 30329, USA), Chad Cadwell, Nasima M. Camp (Department of Health, Research, Informatics, and Technology, ICF, Atlanta, GA, USA), Roberto Cardarelli, Terri Clark, Patrick G. Clay (Department of Pharmacotherapy, University of North Texas Health Science Center System College of Pharmacy, Fort Worth, TX, USA), Andrew Crim, Angela Cure, Kristin Darin, Traci Dean, Ambrose Delpino, Michael DeMayo, Shara Elrod, Ashley L. Eschmann, David Farmer, Rose Farnan, Heather Free, Andrew Gudzelak Jr., Andrew Halbur, Felicia Hardnett (Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, 1600 Clifton Rd., MS US8-4, Atlanta, GA, 30329, USA), Ronald Hazen, Heidi Hilker, John Hou (Health Analytics, Research, and Reporting Department, Walgreen Co., Deerfield, IL, USA), Brian Hujdich, Lisa Johnson, Heather Kirkham, James Lecounte, Sayuri Lio, Guanzhong Lo, Mazzoni Center HIV Care Team of Clinicians, Sondra Middleton, Brittany Mills, Stacy Muckelroy, Christopher M. Nguyen, Linda Ortiz, Glen Pietrandoni, Kimberly K. Scarsi, Jon Schommer, Michael D. Shankle (HealthHIV, Washington, DC, USA), Ram Shrestha, Daron Smith, Sumihiro Suzuki (Department of Biostatistics and Epidemiology, University of North Texas Health Science Center, Fort Worth, TX, USA), Michael S. Taitel (Health Analytics, Research, and Reporting Department, Walgreen Co., Deerfield, IL, USA), Gebeyehu N. Teferi, Vikas Tomer, Louis Torres, Paul J. Weidle (Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, 1600 Clifton Rd., MS US8-4, Atlanta, GA, 30329, USA), Carmelita Whitfield, and Jason E. Willman.

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Authors and Affiliations

  1. Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, 1600 Clifton Rd. NE, MS US8-4, Atlanta, GA, 30329, USA

    Kathy K. Byrd, Felicia Hardnett & Paul J. Weidle

  2. Health Analytics, Research, and Reporting Department, Walgreen Co., Deerfield, IL, USA

    John G. Hou & Michael S. Taitel

  3. Department of Pharmacotherapy, University of North Texas Health Science Center System College of Pharmacy, Fort Worth, TX, USA

    Patrick G. Clay

  4. Department of Biostatistics and Epidemiology, University of North Texas Health Science Center, Fort Worth, TX, USA

    Sumihiro Suzuki

  5. Department of Health, Research, Informatics, and Technology, ICF, Atlanta, GA, USA

    Nasima M. Camp

  6. HealthHIV, Washington, DC, USA

    Michael D. Shankle

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the Patient-Centered HIV Care Model Team

  • Kathy K. Byrd
  • , Felicia Hardnett
  • , John G. Hou
  • , Patrick G. Clay
  • , Sumihiro Suzuki
  • , Nasima M. Camp
  • , Michael D. Shankle
  • , Paul J. Weidle
  •  & Michael S. Taitel

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Correspondence to Kathy K. Byrd.

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The findings and conclusions of this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention.

The members of Patient-Centered HIV Care Model Team were given in Acknowledgements.

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Byrd, K.K., Hardnett, F., Hou, J.G. et al. Improvements in Retention in Care and HIV Viral Suppression Among Persons with HIV and Comorbid Mental Health Conditions: Patient-Centered HIV Care Model. AIDS Behav 24, 3522–3532 (2020). https://doi.org/10.1007/s10461-020-02913-2

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