Timing of Antiretroviral Therapy Initiation in a Nationally Representative Sample of HIV-Infected Adults Receiving Medical Care in the United States

Adedinsewo, Demilade; Wei, Stanley C.; Robertson, McKaylee; Rose, Charles E.; Johnson, Christopher H.; Dombrowski, Julie; Skarbinski, Jacek

doi:10.1089/apc.2014.0194

Cited by 19 publications

(9 citation statements)

References 28 publications

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“…The time to ART initiation for our overall cohort was 1.5 months, less than time to ART for HIV-infected persons with and without AIDS cited in other studies, 5 but greater than the target goal of less than 2 weeks to improve morbidity and mortality. Reasons for shorter time to ART initiation in our study sample may include the fact that outpatient referral from Grady Hospital is streamlined to a well-organized large Ryan White–funded clinic that is in close geographic proximity to GMH, and the clinic has a volume of HIV-positive patients cared for primarily by academic HIV providers who may be more likely than providers to implement guidelines recommending earlier ART initiation in other settings.…”

Section: Discussionmentioning

confidence: 58%

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A Minority of Patients Newly Diagnosed with AIDS Are Started on Antiretroviral Therapy at the Time of Diagnosis in a Large Public Hospital in the Southeastern United States

Goswami

Colasanti

Khoubian

et al. 2017

J Int Assoc Provid AIDS Care

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Prompt antiretroviral therapy (ART) initiation after AIDS diagnosis, in the absence of certain opportunistic infections such as tuberculosis and cryptococcal meningitis, delays disease progression and death, but system barriers to inpatient ART initiation at large hospitals in the era of modern ART have been less studied. We reviewed hospitalizations for persons newly diagnosed with AIDS at Grady Memorial Hospital in Atlanta, Georgia in 2011 and 2012. Individual- and system-level variables were collected. Logistic regression models were used to estimate the odds ratios (ORs) for ART initiation prior to discharge. With Georgia Department of Health surveillance data, we estimated time to first clinic visit, ART initiation, and viral suppression. In the study population (n = 81), ART was initiated prior to discharge in 10 (12%) patients. Shorter hospital stay was significantly associated with lack of ART initiation at the time of HIV diagnosis (8 versus 24 days, OR: 1.14, 95% confidence interval: 1.04-1.25). Reducing barriers to ART initiation for newly diagnosed HIV-positive patients with short hospital stays may improve time to viral suppression.

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Section: Discussionmentioning

confidence: 58%

“…4 Yet, median time to ART initiation for HIV-infected adults receiving medical care in the United States has been estimated as long as 10 months, with even longer times to initiation for African Americans, women, and persons living at or below the poverty level. 5 …”

Section: Introductionmentioning

confidence: 99%

A Minority of Patients Newly Diagnosed with AIDS Are Started on Antiretroviral Therapy at the Time of Diagnosis in a Large Public Hospital in the Southeastern United States

Goswami

Colasanti

Khoubian

et al. 2017

J Int Assoc Provid AIDS Care

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“…38 Other studies have found disparities in time to ART initiation, with longer time to ART in blacks, uninsured, heterosexual women, MSM, and persons without AIDS. 39 Unlike treatment for other chronic conditions, such as CHF, cirrhosis, or chronic obstructive pulmonary disease, HIV treatment can lead to significant reversal of the main underlying illness. In fact, due to improvement in tolerability and recognition of long-term consequences of viral replication, ART is recommended for virtually all patients with HIV.…”

Section: Discussionmentioning

confidence: 99%

Half of 30-Day Hospital Readmissions Among HIV-Infected Patients Are Potentially Preventable

Nijhawan

Kitchell

Etherton

et al. 2015

AIDS Patient Care and STDs

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Thirty-day readmission rates, a widely utilized quality metric, are high among HIV-infected individuals. However, it is unknown how many 30-day readmissions are preventable, especially in HIV patients, who have been excluded from prior potentially preventable readmission analyses. We used electronic medical records to identify all readmissions within 30 days of discharge among HIV patients hospitalized at a large urban safety net hospital in 2011. Two independent reviewers assessed whether readmissions were potentially preventable using both published criteria and detailed chart review, how readmissions might have been prevented, and the phase of care deemed suboptimal (inpatient care, discharge planning, post-discharge). Of 1137 index admissions, 213 (19%) resulted in 30-day readmissions. These admissions occurred among 930 unique HIV patients, with 130 individuals (14%) experiencing 30-day readmissions. Of these 130, about half were determined to be potentially preventable using published criteria (53%) or implicit chart review (48%). Not taking antiretroviral therapy (ART) greatly increased the odds of a preventable readmission (OR 5.9, CI:2.4-14.8). Most of the preventable causes of readmission were attributed to suboptimal care during the index hospitalization. Half of 30-day readmission in HIV patients are potentially preventable. Increased focus on early ART initiation, adherence counseling, management of chronic conditions, and appropriate timing of discharge may help reduce readmissions in this vulnerable population.

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“…Yet time to ART initiation often remains suboptimal. 4,5 Many barriers exist that influence patients' ability to link, engage and be retained in HIV care, initiate ART, and achieve VS.…”

Section: Introductionmentioning

confidence: 99%

The Perilous Road from HIV Diagnosis in the Hospital to Viral Suppression in the Outpatient Clinic

ColasantiJonathan

GoswamiNeela

KhoubianJonathan

et al. 2016

AIDS Research and Human Retroviruses

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The HIV care continuum has received considerable attention in recent years, however, few care continua focus on the population of patients who are diagnosed during an inpatient hospital admission. We aimed to describe the HIV care continuum for patients newly diagnosed during hospitalization through 24-month follow-up. A retrospective chart review of HIV patients diagnosed at Grady Memorial Hospital from 2011 to 2012 was performed and records were matched to Georgia Department of Public Health HIV/AIDS surveillance data. Descriptive statistics and statistical tests of independence were utilized. Ninety-four new diagnoses were confirmed during the 2-year study period. Median age was 43 years (interquartile range [IQR] 30-51), 77% were male, 72% were non-Hispanic Black, 31% were men who have sex with men (MSM), and 77% were uninsured. Median CD4 count at diagnosis was 134 cells/lL (IQR 30-307). Eighty-four percent received their diagnosis before hospital discharge, 68% linked to care by 90 days, 73% were retained for 12 months, 48% were virologically suppressed by 12 months, 58% were retained for 24 continuous months, and 38% achieved continuous viral suppression (VS) during the initial 24 months after diagnosis. Late diagnosis is a persistent problem in hospitalized patients. Despite relative success with linkage to care and 12-month retention in care, a minority of patients maintained retention and VS for 24 continuous months.

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Timing of Antiretroviral Therapy Initiation in a Nationally Representative Sample of HIV-Infected Adults Receiving Medical Care in the United States

Cited by 19 publications

References 28 publications

A Minority of Patients Newly Diagnosed with AIDS Are Started on Antiretroviral Therapy at the Time of Diagnosis in a Large Public Hospital in the Southeastern United States

A Minority of Patients Newly Diagnosed with AIDS Are Started on Antiretroviral Therapy at the Time of Diagnosis in a Large Public Hospital in the Southeastern United States

Half of 30-Day Hospital Readmissions Among HIV-Infected Patients Are Potentially Preventable

The Perilous Road from HIV Diagnosis in the Hospital to Viral Suppression in the Outpatient Clinic

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