Significant gaps in HIV diagnosis rates, linkage to and retention in HIV care, timely antiretroviral therapy (ART) initiation, and viral load (VL) suppression among persons living with HIV (PLWH) undermine the potential impact of 'treatment as prevention' and jeopardize achievement of US National HIV/AIDS Strategy (NHAS) goals. There is a significant need for more rigorous evidence regarding the effectiveness of several promising intervention strategies, some of which are already being implemented alone or in combination. In late 2009, the NYC Department of Health and Mental Hygiene (DOHMH) began implementing a comprehensive Care Coordination Program (CCP) at 28 Ryan White-funded agencies, targeting patients at high risk for suboptimal care cascade outcomes. The CCP intervention combines various evidence-based programmatic elements into a package, including case management, patient navigation, directly observed therapy (DOT), structured health promotion in home/field visits, and outreach to assist patients in accessing needed care and related services. The purpose of this retrospective cohort study, led jointly by investigators from the CUNY School of Public Health at Hunter College and the NYCDOHMH, is to: 1) assess the effectiveness of the CCP intervention by comparing primary outcomes among CCP participants with those of similar PLWH in HIV care who do not receive the CCP intervention; 2) among those who enroll in CCP, identify individual and program-level determinants of care engagement and VL suppression up to 36 months following CCP enrollment; and 3) assess the cost-effectiveness (cost per quality-adjusted life year [QALY]) of the CCP relative to usual care outside the CCP, considering downstream cost-savings and individual and public health benefits due to improved VL suppression and HIV infections averted. We expect the proposed research to generate much- needed evidence related to the effectiveness, outcome determinants, and cost-effectiveness of a promising, scalable service delivery strategy, ultimately enabling HIV care programs to further evolve achieve the greatest possible uptake and impact.
The US spends billions per year in taxpayer dollars on the domestic response to the HIV/AIDS epidemic. While effective treatment is available that improves survival and reduces spread of the virus to others, the number of new annual HIV infections remains relatively constant in the US, and only about half of people with HIV are receiving care and treatment. This project has the potential to greatly improve our ability achieve better results from HIV care and treatment programs by exploring promising strategies to make them more effective, efficient and cost-effective. Ultimately, the information gained through this research will help improve HIV care programs such that people with HIV become more engaged in HIV care, and start and maintain their treatment earlier. This in turn will improve their survivl while also reducing the spread of HIV infection to others. It will also help HIV care programs identify ways to get more 'bang for the buck' as they make decisions on how best to improve their programs with limited available resources.
