Impact of Multicomponent Support Strategies on Human Immunodeficiency Virus Virologic Suppression Rates During Coronavirus Disease 2019: An Interrupted Time Series Analysis

Spinelli, Matthew A; Tourneau, Noelle Le; Glidden, David V.; Hsu, Ling; Hickey, Matthew D.; Imbert, Elizabeth; Arreguin, Mireya; Jain, Jennifer; Oskarsson, Jon; Buchbinder, Susan; Johnson, Mallory O.; Havlir, Diane V.; Christopoulos, Katerina; Gandhi, Monica

doi:10.1093/cid/ciac179

Cited by 7 publications

(2 citation statements)

References 28 publications

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“…17 As a result, they implemented a multicomponent intervention, including scaling up in-person visits for vulnerable PWH, which resulted in increased rates of virologic suppression. 29 Additional studies are needed to tailor telemedicine to the care needs of diverse populations of PWH. 30 Limitations of our study include its nonrandomized, observational design.…”

Section: Discussionmentioning

confidence: 99%

Telemedicine and HIV Care Quality Measures During the COVID-19 Pandemic

Masters,

Rivera,

Calamari

et al. 2023

JAIDS Journal of Acquired Immune Deficiency Syndromes

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Background: During the COVID-19 pandemic, telemedicine was adopted to ensure continuity of HIV care. We examined how introducing televisits affected technical quality of care for people with HIV (PWH) during this time. Methods: PWH receiving HIV care at Howard Brown Health Centers and Northwestern University in Chicago, Illinois were included. HIV care quality indicators were calculated using data extracted from electronic medical records during 4 timepoints every 6 months from March, March 1, 2020 to September 1, 2021. Generalized linear mixed models estimated differences in indicators across timepoints within each site while controlling for multiple observations of individuals. Generalized linear mixed models were also used to compare differences in outcomes among PWH who attended all versus a combination of in-person and televisits versus no televisits across the study time periods. Results: 6447 PWH were included in the analysis. Compared with prepandemic levels, there were significant declines in care utilization and processes of care measures. Measures of HIV virologic suppression, blood pressure control, and HbA1C <7% (in both people with and without diabetes) were stable with no significant differences noted across the study timepoints. Similar trends were observed across all age, race, and sex subgroups. In multivariable models, televisits were not associated with decreased HIV viral suppression. Conclusions: During the COVID-19 pandemic and rapid implementation of televisits, indicators of care utilization and processes of care decreased compared with prepandemic levels. Among PWH who remained in care, televisits were not associated with worse virologic, blood pressure, and glycemic control in PWH.

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Section: Discussionmentioning

confidence: 99%

Telemedicine and HIV Care Quality Measures During the COVID-19 Pandemic

Masters,

Rivera,

Calamari

et al. 2023

JAIDS Journal of Acquired Immune Deficiency Syndromes

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“…Across the HIV treatment cascade, mental illness has been associated with poorer outcomes overall, but individuals with SMI in particular have low rates of HIV testing [5], antiretroviral therapy prescriptions [6,7], and viral suppression when compared to the general HIV population [8,9]. Moreover, prior improvements in care across the HIV care continuum (e.g., improvements in viral suppression) have slowed due to the COVID-19 pandemic [10], making it possible that vulnerable subpopulations of PLWH have experienced even further setbacks. Despite these disparities, few studies have explored the role of COVID on accessing both HIV and behavioral health care for PLWH and comorbid behavioral health issues, particularly SMI.…”

Section: Introductionmentioning

confidence: 99%

Care challenges and silver linings in HIV and behavioral health service delivery for individuals living with HIV and severe mental illness during the COVID-19 pandemic: a qualitative study

Dahiya,

Riano,

Dilley

et al. 2024

BMC Health Serv Res

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Background There has been a longstanding effort to integrate behavioral health and HIV care for people with comorbid HIV and behavioral health needs, including those with severe mental illness (SMI). As this population frequents both behavioral health and HIV care settings, they were likely to experience new obstacles to the quality and availability of care during the COVID-19 pandemic. This study aims to describe how clinics for HIV services or behavioral healthcare—as well as co-located sites providing both—sought to rapidly shift protocols to maintain a standard of patient care for people with comorbid HIV and SMI while adapting to the unprecedented circumstances of the pandemic. Methods We interviewed HIV and behavioral healthcare providers, clinic leaders, and support service agencies that served clients impacted by both HIV and SMI. Seventeen key informants across three settings (HIV care settings, behavioral health care settings, and integrated or co-located care settings) were interviewed in 2022. Interviews focused on changes in clinical services, protocols, and care provision strategies during and at the onset of the COVID-19 pandemic. Interviews were transcribed and coded using thematic analysis. Results Commonly endorsed themes included both positive and negative changes in care and care provision during the pandemic. Negative impacts of the pandemic included the loss of physical space, exacerbated mental health needs and disengagement in HIV care, patient barriers to telehealth and the digital divide, and increased healthcare workforce burnout. Positive changes included improved healthcare delivery and care engagement through telehealth, new opportunities to provide a wide range of social services, paradoxical increases in engagement in HIV care for certain patients, and broad institution of workforce wellness practices. Conclusions Though COVID-19 presented several complex barriers to care for providers serving patients with comorbid HIV and SMI, the increased flexibility afforded by telehealth and a greater focus on collaborative approaches to patient care may benefit this patient population in the future. Additionally, the focus on workforce wellness may serve to increase retention and avoid burnout among providers. The strategies and lessons learned through adapting to COVID-19 may be invaluable moving forward as healthcare systems respond to future pandemics.

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A Systematic Review: Impact of SARS-CoV-2 Infection on Morbidity, Mortality, and Viral Suppression in Patients Living With HIV

Hanson

Kim

Badowski

2023

SN Compr. Clin. Med.

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People living with HIV (PLWH) are a vulnerable patient population due to their immunosuppressed state and the risks associated with interruptions in treatment. After the unprecedented start of the COVID-19 pandemic, PLWH experienced complications involving interruptions in care and treatment, potentially leading to adverse outcomes including reduced rates of viral suppression, increased hospitalizations, and death. A systematic, comprehensive literature search was completed using PubMed, Google Scholar, and bibliography review to identify relevant articles related to clinical outcomes of HIV and SARS-CoV-2 co-infection. Related keywords were used as search terms: “COVID”, “SARS-CoV-2”, “coronavirus”, “HIV”, “viral load”, “viral suppression”, and “disease severity”. Of the 492 results, 7 systematic reviews and 14 individual studies were included in the current review of literature regarding COVID-19-related outcomes in PLWH. In total, 2 systematic reviews and 8 individual studies found an increased rate of mortality, hospitalizations, and/or severe COVID-19 outcomes in PLWH co-infected with SARS-CoV-2, whereas the other 5 systematic reviews and 6 individual studies concluded PLWH were not at an increased risk compared to patients without HIV. Regarding viral suppression, 4 of 5 studies found viral suppression in PLWH was not impacted by the COVID-19 pandemic. The current literature suggests that the morbidity and mortality associated with SARS-CoV-2 infection in PLWH is complex and involves multiple factors including age and comorbid conditions; however, there is no clear consensus thus far. In contrast, literature consistently demonstrates that viral suppression during the pandemic has remained unchanged, potentially due to increased implementation of telemedicine and multicomponent interventions deployed.

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Impact of Multicomponent Support Strategies on Human Immunodeficiency Virus Virologic Suppression Rates During Coronavirus Disease 2019: An Interrupted Time Series Analysis

Cited by 7 publications

References 28 publications

Telemedicine and HIV Care Quality Measures During the COVID-19 Pandemic

Telemedicine and HIV Care Quality Measures During the COVID-19 Pandemic

Care challenges and silver linings in HIV and behavioral health service delivery for individuals living with HIV and severe mental illness during the COVID-19 pandemic: a qualitative study

A Systematic Review: Impact of SARS-CoV-2 Infection on Morbidity, Mortality, and Viral Suppression in Patients Living With HIV

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