Study Suggests Veterans with HIV Treated at Clinics with Integrated Specialty Services More Likely to Achieve Better Outcomes
The ability of combination antiretroviral therapy (cART) to suppress replication of HIV has provided enormous clinical and survival benefits to patients infected with this virus. However, adherence to treatment regimens remains a challenge, and comorbidities such as substance use disorders, mental health disorders, hepatitis C infection, and diabetes are associated with lower adherence. The most common way HIV clinics address comorbidities is by integrating non-infectious disease providers (e.g., psychiatrists and social workers) into HIV primary care. This retrospective cohort study evaluated the association between Integrated HIV Care (IHC) and patient outcomes among 1018 Veterans with HIV who received care at five VA facilities from 2000-2006. Controlling for demographics and clinic factors, investigators used VA data to evaluate the effect of IHC on the likelihood of achieving viral suppression while on cART.
Findings show that Veterans who visited HIV clinics with more integrated specialty services were more likely to achieve viral suppression. In particular, Veterans visiting clinics that offered hepatitis, psychiatric, psychological, and social services in addition to primary care and HIV specialty services were three times more likely to achieve viral suppression than Veterans visiting clinics that offered only primary care and HIV specialty services. Results also showed that 93% of Veterans in this study had one or more comorbid conditions, with a mean of 3.2 comorbidities. The most prevalent were mental disorders (55.5%), prior or current hepatitis B infection (48.8%), hepatitis C infection (33.1%), and illicit drug or alcohol use (31.4%).
The authors suggest that resources should be allocated to integrate sub-specialty services into HIV primary care clinics, and that providers should direct patients toward these clinics and retain them in care. Moreover, these results may be relevant not only to the care of Veterans with HIV, but also to the care of patients with other complex medical issues that require principal care in sub-specialty clinics.
Hoang T, Goetz M, Yano E, Rossman B, Anaya H, Knapp H, Korthuis P, Henry R, Bowman C, Gifford A, and Asch S. The impact of integrated HIV care on patient health outcomes. Medical Care May 2009;47(5):560-567.
This study was funded through VA/HSR&D's HIV/Hepatitis Quality Enhancement Research Initiative (QUERI). Drs. Goetz, Henry, Gifford, and Asch are part of HIV/Hepatitis QUERI.