Setting and organization of care for persons living with HIV/AIDS

Handford, Curtis; Tynan, Anne‐Marie; Rackal, Julia; Glazier, Richard H.

doi:10.1002/14651858.cd004348.pub2

Cited by 47 publications

(51 citation statements)

References 94 publications

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“…However, our results regarding facility volume were less convincing than those in previously published reviews (Handford et al, 2012;Handford, Tynan, Rackal, & Glazier, 2006). These reviews differ in the sense that they included many studies that took place before the introduction of cART.…”

Section: Discussioncontrasting

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: Discussioncontrasting

confidence: 99%

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

et al. 2016

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“…1,2 In recent years, these clinics have increasingly developed systems and expertise necessary to deliver comprehensive primary care for an aging population of persons with HIV infection. However, this model does not adapt to rural and low HIV prevalence settings, where there are few healthcare providers with expertise in HIV medicine, and distances between patients and HIV specialty clinics are often great.…”

Section: Introductionmentioning

confidence: 99%

Mixed-Methods Evaluation of a Telehealth Collaborative Care Program for Persons with HIV Infection in a Rural Setting

et al. 2013

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“…Historically, the predominant source of HIV care has been in HIV/infectious diseases specialty clinics. [15][16][17] Given the numerous advances to combination ARV, HIV has now evolved into a chronic disease that can be managed in the outpatient care setting. 18 Nevertheless, there is still the need for specialty training for any provider caring for PLWH, particularly primary care providers practicing in nonspecialty settings.…”

Section: Discussionmentioning

confidence: 99%

Engagement in Outpatient Care for Persons Living with HIV in the United States

Oramasionwu

Bailey²,

Johnson³

et al. 2015

AIDS Research and Human Retroviruses

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Prior studies that have assessed engagement within the various stages of care for persons living with HIV (PLWH) studied patients receiving care in HIV medical care facilities. These data are not representative of care received throughout the United States, as not all PLWH receive care in HIV clinics. This study evaluated engagement in outpatient care and healthcare utilization for PLWH, beyond facilities that specialize in HIV. Cross-sectional data were from the 2009-2010 National Hospital Ambulatory Medical Care Survey. Levels of care included receiving any care, receiving HIV-related care, established in care, engaged in care, and prescribed antiretroviral therapy (ARV). Factors associated with ARV prescription were determined by logistic regression. We analyzed data for *2.6 million outpatient clinic visits for PLWH. Of these, 90% were receiving HIV-related care, 86% were established in care, 75% were engaged in care, and 65% were prescribed ARV. In stratified analysis, the proportion of PWLH who were engaged in care varied by race/ethnicity ( p < 0.001) and ARV prescription varied significantly across the three age groups ( p = 0.004). Clinic visits within the past year did not differ for those prescribed ARV vs. not prescribed ARV [median, IQR = 3.3 visits (1.8-5.6) vs. 3.6 visits (1.3-5.9); p = 0.7]. Seeing a physician was associated with ARV prescription (OR = 0.27, 95% CI = 0.15-0.51), whereas routine engagement in care was not associated with ARV prescription (OR = 0.99, 95% CI = 0.96-1.03). Given that non-ARV-treated PLWH utilized outpatient care services at rates similar to ARV-treated PLWH, these routine clinic visits are missed opportunities for increasing ARV prescription in untreated patients.

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Setting and organization of care for persons living with HIV/AIDS

Cited by 47 publications

References 94 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

Mixed-Methods Evaluation of a Telehealth Collaborative Care Program for Persons with HIV Infection in a Rural Setting

Engagement in Outpatient Care for Persons Living with HIV in the United States

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