Short-term effectiveness of HIV care coordination among persons with recent HIV diagnosis or history of poor HIV outcomes

Nash, Denis; Robertson, McKaylee; Penrose, Katherine; Chamberlin, Stephanie; Robbins, Rebekkah S.; Braunstein, Sarah L.; Myers, Julie E.; Abraham, Bisrat; Kulkarni, Sarah; Levin, Bruce; Irvine, Mary K.

doi:10.1371/journal.pone.0204017

Cited by 23 publications

(11 citation statements)

References 31 publications

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“…The primary outcome, timely VS (TVS), is defined as VL <200 copies/mL on any VL test reported in the 6-month period following inclusion on a D2S report due to unsuppressed VL. Consistent with our prior work,62–65 those without any VL measure during follow-up will be considered not to have achieved VS, given their lack of documented clinical monitoring since their last unsuppressed VL. The 6-month follow-up period allows sufficient time to capture changes in VS status, based on US Department of Health and Human Services HIV guidelines, which reinforce the standard practice of VL monitoring every 3–4 months, or more often when adherence difficulties are apparent, and every 4–8 weeks until VS is reached, for PWH starting or changing ART regimens 66.…”

Section: Methods and Analysismentioning

confidence: 69%

Study protocol for data to suppression (D2S): a cluster-randomised, stepped-wedge effectiveness trial of a reporting and capacity-building intervention to improve HIV viral suppression in housing and behavioural health programmes in New York City

et al. 2023

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IntroductionWith progress in the ‘diagnose’, ‘link’ and ‘retain’ stages of the HIV care continuum, viral suppression (VS) gains increasingly hinge on antiretroviral adherence among people with HIV (PWH) retained in care. The Centers for Disease Control and Prevention estimate that unsuppressed viral load among PWH in care accounts for 20% of onward transmission. HIV intervention strategies include ‘data to care’ (D2C)—using surveillance to identify out-of-care PWH for follow-up. However, most D2C efforts target care linkage, not antiretroviral adherence, and limit client-level data sharing to medical (versus support-service) providers. Drawing on lessons learnt in D2C and successful local pilots, we designed a ‘data-to-suppression’ intervention that offers HIV support-service programmes surveillance-based reports listing their virally unsuppressed clients and capacity-building assistance for quality-improvement activities. We aimed to scale and test the intervention in agencies delivering Ryan White HIV/AIDS Programme-funded behavioural health and housing services.Methods and analysisTo estimate intervention effects, this study applies a cross-sectional, stepped-wedge design to the intervention’s rollout to 27 agencies randomised within matched pairs to early or delayed implementation. Data from three 12-month periods (pre-implementation, partial implementation and full implementation) will be examined to assess intervention effects on timely VS (within 6 months of a report listing the client as needing follow-up for VS). Based on projected enrolment (n=1619) and a pre-implementation outcome probability of 0.40–0.45, the detectable effect size with 80% power is an OR of 2.12 (relative risk: 1.41–1.46).Ethics and disseminationThis study was approved by the New York City Department of Health and Mental Hygiene’s institutional review board (protocol: 21–036) with a waiver of informed consent. Findings will be disseminated via publications, conferences and meetings including provider-agency representatives.Trial registration numberNCT05140421.

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Section: Methods and Analysismentioning

confidence: 69%

Study protocol for data to suppression (D2S): a cluster-randomised, stepped-wedge effectiveness trial of a reporting and capacity-building intervention to improve HIV viral suppression in housing and behavioural health programmes in New York City

et al. 2023

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“…It is not clear whether our trial's findings reflect a null difference in effectiveness between the revised and original CCP (which has already shown superiority to usual care 20,21,44 ) or reflect incomplete implementation of revised-CCP components during the trial. Analyses to date have not detected significant implementation variability in relation to the outcome, but our implementation measure may be insufficiently sensitive to such variability.…”

Section: Contextualization Of Null Findingsmentioning

confidence: 86%

Evaluation of the Revised Versus Original Ryan White Part A HIV Care Coordination Program in a Cluster-Randomized, Stepped-Wedge Trial

Irvine

Levin

Abdelqader

et al. 2022

JAIDS Journal of Acquired Immune Deficiency Syndromes

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Background: To address challenges with delivery of an evidencebased HIV care coordination program (CCP), the New York City Health Department initiated a CCP redesign. We conducted a siterandomized stepped-wedge trial to evaluate effectiveness of the revised versus the original model. Setting:The CCP is delivered in New York City hospitals, community health centers, and community-based organizations to people experiencing or at risk for poor HIV outcomes. Methods:The outcome, timely viral suppression (TVS), was defined as achievement of viral load ,200 copies/mL within 4 months among enrollees with unsuppressed viral load ($200 copies/mL). Seventeen original-CCP provider agencies were randomized within matched pairs to early (August 2018) or delayed (May 2019) starts of revised-model implementation. Data from 3 periods were examined to compare revised versus original CCP effects on TVS. The primary analysis of the intervention effect applied fully conditional maximum likelihood estimation together with an exact, conditional P-value and an exact test-based 95% CI. We assigned each trial enrollee the implementation level of their site (based on a three-component measure) and tested for association with TVS, adjusting for period and study arm.Results: Over 3 nine-month periods, 960 individuals were eligible for trial inclusion (intention to treat). The odds ratio of TVS versus no TVS comparing revised with original CCP was 0.88 (95% CI: 0.45, 1.7). Thus, the revised program yielded slightly lower TVS, although the effect was statistically nonsignificant. TVS was not significantly associated with revised-CCP implementation level. Conclusion:Program revisions did not increase TVS, irrespective of the implementation level.

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“…The initial CCP was implemented at 28 Ryan White Part A‐funded agencies, reaching over 7000 clients in less than 4 years. The CCP demonstrated modest benefits for viral load suppression among newly diagnosed PWH and previously diagnosed but consistently unsuppressed PWH [ 10 , 14 , 15 ]. Following an outline developed by the NYC Health Department and the local Ryan White Part A Community Planning Council, refinements to the CCP were implemented in 2018 to enhance intervention delivery, engagement and impact, and to reduce implementation barriers.…”

Section: Introductionmentioning

confidence: 99%

Provider preferences for delivery of HIV care coordination services: results from a discrete choice experiment

et al. 2022

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Introduction:The PROMISE study was launched in 2018 to assess and document the implementation of changes to an existing HIV Care Coordination Programme (CCP) designed to address persistent disparities in care and treatment engagement among persons with HIV in New York City. We evaluated provider endorsement of features of the CCP to understand drivers of engagement with the programme. Methods: We used a discrete choice experiment to measure provider endorsement of four CCP attributes, including: (1) how CCP helps with medication adherence, (2) how CCP helps with primary care appointments, (3) how CCP helps with issues other than primary care and (4) where CCP visits take place (visit location). Each attribute had three to four levels. Our primary outcomes were relative importance and part-worth utilities, measures of preference for the levels of the four CCP program attributes, estimated using a hierarchical-Bayesian multinomial logit model. All non-medical providers in the core CCP positions of patient navigator, care coordinator and programme director or other administrator from each of the 25 revised CCP-implementing agencies were eligible to participate. Results: We received responses from 152 providers, 68% of whom identified as women, 49% identified as Latino/a, 34% identified as Black and 60% were 30-49 years old. Visit location (28.6%, 95% confidence interval [CI] 27.0-30.3%) had the highest relative importance, followed by how staff help with ART adherence (24.3%, 95% CI 22.4-26.1%), how staff help with issues other than primary care (24.2%, 95% CI 22.7-25.7%) and how staff help with primary care appointments (22.9%, 95% CI 21.7-24.1%). Within each of the above attributes, respectively, the levels with the highest part-worth utilities were home visits 60 minutes from the program or agency (utility 19.9, 95% CI 10.7-29.0), directly observed therapy (utility 26.1, 95% CI 19.1-33.1), help with non-HIV specialty medical care (utility 26.5, 95% CI 21.5-31.6) and reminding clients about and accompanying them to primary care appointments (utility 20.8, 95% CI 15.6-26.0). Conclusions: Ongoing CCP refinements should account for how best to support and evaluate the intensive CCP components endorsed by providers in this study.

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Short-term effectiveness of HIV care coordination among persons with recent HIV diagnosis or history of poor HIV outcomes

Cited by 23 publications

References 31 publications

Study protocol for data to suppression (D2S): a cluster-randomised, stepped-wedge effectiveness trial of a reporting and capacity-building intervention to improve HIV viral suppression in housing and behavioural health programmes in New York City

Study protocol for data to suppression (D2S): a cluster-randomised, stepped-wedge effectiveness trial of a reporting and capacity-building intervention to improve HIV viral suppression in housing and behavioural health programmes in New York City

Evaluation of the Revised Versus Original Ryan White Part A HIV Care Coordination Program in a Cluster-Randomized, Stepped-Wedge Trial

Provider preferences for delivery of HIV care coordination services: results from a discrete choice experiment

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