TY - JOUR
T1 - HIV care cascade before and after hospitalization
T2 - impact of a multidisciplinary inpatient team in the US South
AU - Nijhawan, A. E.
AU - Bhattatiry, M.
AU - Chansard, M.
AU - Zhang, S.
AU - Halm, E. A.
N1 - Funding Information:
AN receives research funding from the Gilead FOCUS program; Agency for Healthcare Research and Quality [grant number R24 HS 022418]; National Institute of Allergy and Infectious Diseases [grant number K23 AI 112477]; National Institute on Drug Abuse [grant number R34 DA 045592] NIH K23 AI 112477, NIH R34 DA 045592, AHRQ R24 HS 022418
Publisher Copyright:
© 2019 Informa UK Limited, trading as Taylor & Francis Group.
PY - 2020/11/1
Y1 - 2020/11/1
N2 - Hospitalization represents a unique opportunity to re-engage out-of-care individuals, improve HIV outcomes and reduce health disparities. Electronic health records of HIV-positive individuals hospitalized at an urban, public hospital between September 2013 and December 2015 were reviewed. In October 2014, a multidisciplinary HIV consult team (HIV specialist, case manager, and transitional care nurse (TCN)) was implemented. Engagement in care, retention in care and virologic suppression before and after hospitalization were compared between the pre- and post-intervention periods and by treatment received. Of 1056 inpatient admissions (pre-intervention = 571, post-intervention = 485), the majority were among males (69%) and racial/ethnic minorities (55% Black, 23% Hispanic). Each step of the HIV care cascade increased after hospitalization for both time periods (p < 0.01 for each comparison). Those who received the HIV consult (N = 131) or consult + TCN (N = 128) had greater increases in engagement in care (23.7% and 30.5% v. 11.1%, p = 0.04 and <0.01 respectively) and virologic suppression (28.3% and 29.7% v.7.1%, p <0.01 for both) than the no intervention (N = 225) subgroup. Hospitalized patients with HIV have low rates of engagement in care, retention in care and virologic suppression, though all three outcomes improved after hospitalization. A multidisciplinary transitions team improved care engagement and virologic suppression in those who received the intervention.
AB - Hospitalization represents a unique opportunity to re-engage out-of-care individuals, improve HIV outcomes and reduce health disparities. Electronic health records of HIV-positive individuals hospitalized at an urban, public hospital between September 2013 and December 2015 were reviewed. In October 2014, a multidisciplinary HIV consult team (HIV specialist, case manager, and transitional care nurse (TCN)) was implemented. Engagement in care, retention in care and virologic suppression before and after hospitalization were compared between the pre- and post-intervention periods and by treatment received. Of 1056 inpatient admissions (pre-intervention = 571, post-intervention = 485), the majority were among males (69%) and racial/ethnic minorities (55% Black, 23% Hispanic). Each step of the HIV care cascade increased after hospitalization for both time periods (p < 0.01 for each comparison). Those who received the HIV consult (N = 131) or consult + TCN (N = 128) had greater increases in engagement in care (23.7% and 30.5% v. 11.1%, p = 0.04 and <0.01 respectively) and virologic suppression (28.3% and 29.7% v.7.1%, p <0.01 for both) than the no intervention (N = 225) subgroup. Hospitalized patients with HIV have low rates of engagement in care, retention in care and virologic suppression, though all three outcomes improved after hospitalization. A multidisciplinary transitions team improved care engagement and virologic suppression in those who received the intervention.
KW - HIV care cascade
KW - Hospitalization
KW - retention
KW - transition of care
UR - http://www.scopus.com/inward/record.url?scp=85076416660&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85076416660&partnerID=8YFLogxK
U2 - 10.1080/09540121.2019.1698704
DO - 10.1080/09540121.2019.1698704
M3 - Article
C2 - 31809594
AN - SCOPUS:85076416660
SN - 0954-0121
VL - 32
SP - 1343
EP - 1352
JO - AIDS Care - Psychological and Socio-Medical Aspects of AIDS/HIV
JF - AIDS Care - Psychological and Socio-Medical Aspects of AIDS/HIV
IS - 11
ER -