HIV-infected patients and treatment outcomes: an equivalence study of community-located, primary care-based HIV treatment vs. hospital-based specialty care in the Bronx, New York

Chu, Carolyn; Umanski, Galina; Blank, Arthur E.; Grossberg, Robert; Pa, Selwyn

doi:10.1080/09540121.2010.484456

Cited by 30 publications

(48 citation statements)

References 21 publications

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“…The majority were retrospective cohort (n = 12) (Assefa et al, 2012;Backus et al, 2010;Chan et al, 2011;Chu, Umanski, Blank, Grossberg, & Selwyn, 2010;Fatti, Grimwood, & Bock, 2010;Kerr et al, 2012;Kitahata et al, 2003;Landon et al, 2005;Odafe, Idoko, et al, 2012;Odafe, Torpey, et al, 2012;Sherr et al, 2010;Solomon, Flynn, & Lavetsky, 2005) or cross-sectional studies (n = 7) (Anaya, Yano, & Asch, 2004;Boyer et al, 2011;Horberg, Hurley, Silverberg, Kinsman, & Quesenberry, 2007;Saha et al, 2013;Shet et al, 2011;Wilson, Landon, Hirschhorn, et al, 2005). One study had a prospective cohort design (Sangsari et al, 2012), and eight studies did not explicitly state their design strategy.…”

Section: Resultsmentioning

confidence: 99%

Structure and quality of outpatient care for people living with an HIV infection

et al. 2016

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Policy-makers and clinicians are faced with a gap of evidence to guide policy on standards for HIV outpatient care. Ongoing debates include which settings of care improve health outcomes, and how many HIV-infected patients a health-care provider should treat to gain and maintain expertise. In this article, we evaluate the studies that link health-care facility and care provider characteristics (i.e., structural factors) to health outcomes in HIV-infected patients. We searched the electronic databases MEDLINE, PUBMED, and EMBASE from inception until 1 January 2015. We included a total of 28 observational studies that were conducted after the introduction of combination antiretroviral therapy in 1996. Three aspects of the available research linking the structure to quality of HIV outpatient care were evaluated: (1) assessed structural characteristics (i.e., health-care facility and care provider characteristics); (2) measures of quality of HIV outpatient care; and (3) reported associations between structural characteristics and quality of care. Rather than scarcity of data, it is the diversity in methodology in the identified studies and the inconsistency of their results that led us to the conclusion that the scientific evidence is too weak to guide policy in HIV outpatient care. We provide recommendations on how to address this heterogeneity in future studies and offer specific suggestions for further reading that could be of interest for clinicians and researchers.ARTICLE HISTORY

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Section: Resultsmentioning

confidence: 99%

Structure and quality of outpatient care for people living with an HIV infection

et al. 2016

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Section: Discussionmentioning

confidence: 99%

“…More recent work has shown that generalists with either HIV experience or formalized specialist decision support perform equally as well as HIV specialists for ART management. 7,21,37 Physicians in our study practiced in a variety of settings, and potentially reflect a more real-world experience of care delivery to people with HIV.We have previously demonstrated that patients cared for with models in which specialist physicians managed the majority of HIV care had lower rates of cancer screening. 24 As hypothesized, in this study, we found that family physician HIV experience did not influence these primary care outcomes.…”

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confidence: 99%

“…Recent work has found similar quality of HIV-specific care between generalist and specialist physicians, even though the HIV experience of these physicians varied. 7,8 In addition, multidisciplinary care teams with nonexpert family physicians may improve patients' ART adherence more than HIV specialist care alone. 9 Another important consideration is that specialist HIV physicians are less adept than generalists at preventing and managing the common comorbidities emerging with increased HIV longevity.…”

Section: Introductionmentioning

confidence: 99%

“…[10][11][12][13][14][15][16][17][18] There is increasing recognition that the management of HIV requires a primary care presence, but we have a poor understanding of how to integrate HIV-specific expertise within a primary care context. 7,10,[14][15][16][17][18][19][20][21] Overall, it has been difficult to distinguish the respective contributions of physician qualification and physician experience of care to the effectiveness of HIV care. 3 We have previously used routinely collected administrative data to develop and characterize an intuitive typology of shared care for people with HIV based on actual patterns of care.…”

Section: Introductionmentioning

confidence: 99%

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A Population-Based Study Evaluating Family Physicians' HIV Experience and Care of People Living With HIV in Ontario

Kendall

Dujovny

Younger

et al. 2015

The Annals of Family Medicine

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PURPOSE Greater physician experience managing human immunodeficiency virus (HIV) infection has been associated with better HIV-specific outcomes. The objective of this study was to evaluate whether the HIV experience of a family physician modifies the association between the model of care delivery and the quality of care for people living with HIV. METHODSWe retrospectively analyzed data from a population-based observational study conducted between April 1, 2009, and March 31, 2012. A total of 13,417 patients with HIV in Ontario were stratified into 5 possible patterns or models of care. We used multivariable hierarchical logistic regression analyses, adjusted for patient characteristics and pairwise comparisons, to evaluate the modification of the association between care model and indicators of quality of care (receipt of antiretroviral therapy, cancer screening, and health care use) by level of physician HIV experience (≤5, 6-49, ≥50 patients during study period). RESULTSThe majority of HIV-positive patients (52.8%) saw family physicians exclusively for their care. Among these patients, receipt of antiretroviral therapy was significantly lower for those receiving care from family physicians with 5 or fewer patients and 6-49 patients compared with those with 50 or more patients CONCLUSIONS Family physician HIV experience was strongly associated with receipt of antiretroviral therapy by HIV-positive patients, especially among those seeing only family physicians for their care. Future work must determine the best models for integrating and delivering comprehensive HIV care among diverse populations and settings. Ann Fam Med 2015;13:436-445. doi: 10.1370/afm.1822. INTRODUCTIONA ntiretroviral therapy (ART) has substantially reduced the mortality and morbidity arising from human immunodeficiency virus (HIV) infection, thus shifting the care needs of people living with longstanding HIV. Evidence suggests that clinicians with more HIV training, HIV experience, or both provide higher quality of care as measured by disease-specific indicators, including ART prescribing. [1][2][3][4][5][6] Many of these studies, however, were performed early in the ART era, when both disease and treatments were novel and complex. Recent work has found similar quality of HIV-specific care between generalist and specialist physicians, even though the HIV experience of these physicians varied. 7,8 In addition, multidisciplinary care teams with nonexpert family physicians may improve patients' ART adherence more than HIV specialist care alone. 9 Another important consideration is that specialist HIV physicians are less adept than generalists at preventing and managing the common comorbidities emerging with increased HIV longevity. [10][11][12][13][14][15][16][17][18] increasing recognition that the management of HIV requires a primary care presence, but we have a poor understanding of how to integrate HIV-specific expertise within a primary care context. 7,10,[14][15][16][17][18][19][20][21] Overall, it has been difficult to distin...

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Decentralising HIV treatment in lower- and middle-income countries

Kredo

Ford

Adeniyi

et al. 2013

Cochrane Database of Systematic Reviews

126

117

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BACKGROUND: Policy makers, health staff and communities recognise that health services in lower-and middle-income countries need to improve people's access to HIV treatment and retention to treatment programmes. One strategy is to move antiretroviral delivery from hospitals to more peripheral health facilities or even beyond health facilities. This could increase the number of people with access to care, improve health outcomes, and enhance retention in treatment programmes. On the other hand, providing care at less sophisticated levels in the health service or at community-level may decrease quality of care and result in worse health outcomes. To address these uncertainties, we summarised the research studies examining the risks and benefits of decentralising antiretroviral therapy service delivery. OBJECTIVES: To assess the effects of various models that decentralised HIV treatment and care to more basic levels in the health system for initiating and maintaining antiretroviral therapy. METHODS: Search methods: We conducted a comprehensive search to identify all relevant studies regardless of language or publication status (published, unpublished, in press, and in progress) from 1 January 1996 to 31 March 2013, and contacted relevant organisations and researchers. The search terms included "decentralisation", "down referral", "delivery of health care", and "health services accessibility". Selection criteria: Our inclusion criteria were controlled trials (randomised and non-randomised), controlled-before and after studies, and cohorts (prospective and retrospective) in which HIV-infected people were either initiated on antiretroviral therapy or maintained on therapy in a decentralised setting in lower-and middle-income countries. We define decentralisation as providing treatment at a more basic level in the health system to the comparator. Data collection and analysis: Two authors applied the inclusion criteria and extracted data independently. We designed a framework to describe different decentralisation strategies, and then grouped studies against these strategies. Data were pooled using random-effects metaanalysis. Because loss to follow up in HIV programmes is known to include some deaths, we used attrition as our primary outcome, defined as death plus loss to follow-up. We assessed evidence quality with GRADE methodology. MAIN RESULTS: Sixteen studies met the inclusion criteria, all but one were from Africa, comprising two cluster randomised trials and 14 cohort studies. Antiretroviral therapy started at a hospital and maintained at a health centre (partial decentralisation) probably reduces attrition (RR 0.46, 95% CI 0.29 to 0.71, 4 studies, 39 090 patients, moderate quality evidence). There may be fewer patients lost to care with this model (RR 0.55, 95% CI 0.45 to 0.69, low quality evidence). We are uncertain whether there is a difference in attrition for antiretroviral therapy started and maintained at a health centre (full decentralisa

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HIV-infected patients and treatment outcomes: an equivalence study of community-located, primary care-based HIV treatment vs. hospital-based specialty care in the Bronx, New York

Cited by 30 publications

References 21 publications

Structure and quality of outpatient care for people living with an HIV infection

Structure and quality of outpatient care for people living with an HIV infection

A Population-Based Study Evaluating Family Physicians' HIV Experience and Care of People Living With HIV in Ontario

Decentralising HIV treatment in lower- and middle-income countries

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