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The Impact of Integrated HIV Care on Patient Health Outcomes

The Impact of Integrated HIV Care on Patient Health Outcomes. Tuyen Hoang, PhD Matthew B. Goetz, MD, Elizabeth Yano, PhD, Barbara Rossman, PhD, Henry D. Anaya, PhD, Herschel Knapp, PhD, Steven M. Asch, MD MPH. Background. The key factor to control HIV is adherence to HIV medications

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The Impact of Integrated HIV Care on Patient Health Outcomes

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  1. The Impact of Integrated HIV Care on Patient Health Outcomes Tuyen Hoang, PhD Matthew B. Goetz, MD, Elizabeth Yano, PhD, Barbara Rossman, PhD, Henry D. Anaya, PhD, Herschel Knapp, PhD, Steven M. Asch, MD MPH

  2. Background • The key factor to control HIV is adherence to HIV medications • Co-morbidities impede adherence Mental disorders Substance abuse Hepatitis C

  3. Integrated HIV Care in the VA HIV SPECIALIST SOCIAL WORKER PHARMACIST PSYCHIATRIST PSYCHOLOGIST

  4. Research Questions • Would integrated HIV care enable providers to manage co-morbidities more effectively? • Would access to more comprehensive integrated care lead to better control of HIV?

  5. Study Design Study population • Retrospective cohort of HIV-infected veterans • Five VA facilities in western U.S. • Oct 2000 to April 2006 Eligibility criteria • Receiving HIV treatment in the VA • Sufficient baseline severity • 3+ months of follow-up

  6. Data Sources Quantitative • VA regional data warehouse: demographics, visits, lab tests, diagnoses, pharmacy prescriptions and refills Qualitative • Interviews with chiefs of the HIV clinics to obtain descriptions of integrated services

  7. Four Levels of Comprehensiveness

  8. Distribution of Integrated HIV Care Users (N=1,069) 57% 27% 8% 5% 3% I only II only III only IV only Single-level users Multi-level users

  9. Utilization Index

  10. Survival Analyses First analysis(N=459 single-level users) Time to viral suppression  comprehensive levels Second analysis(N=610 multi-level users) Time to viral suppression  utilization index

  11. Demographics of Study Patients

  12. Clinical characteristics of Patients

  13. Factors Associated with Viral Suppression

  14. Factors Associated withViral Suppression

  15. Conclusions + Hepatitis Psychiatric Psychological Social services HIV primary care Viral suppression 2.6 times more likely

  16. Implications • Resources should be allocated to channel patients toward comprehensive integrated HIV care clinics • Findings may be relevant for other chronic conditions that require principle care in subspecialty clinics

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