Category: Professional Posters
Purpose: The Health Sources & Resources Administration (HSRA) is committed to improving the quality of patient care for people with HIV (PWH) through its Ryan White programs. HSRA provides a series of activities that focus on enhancing the treatment quality and encourages PWH to complete one medical visit in each 6-month period of the 24-month period in order to achieve and maintain virologic suppression. We hypothesize that meeting HSRA visit criteria will correlate with virologic suppression in PWH.
Methods: We conducted a single-center, retrospective cohort study of HIV infected adults (≥19 years) receiving care at a Midwestern HIV clinic between January 1, 2017 and December 31, 2018, with at least 1 HIV RNA reading during the study period. Visit recordings for each 6-month period over the previous 24-month period were collected for each patient to determine the proportion of patients meeting HRSA recommendations. The last HIV RNA in 2018 was used as the virologic suppression endpoint (HIV RNA ≤50 copies/mL). Sociodemographic, ART regimen, ART adherence, comorbidities and other clinical characteristics were abstracted from the Nebraska HIV registry. Pearson Chi-squared tests and binary logistic regression were used to determine the impact of HSRA visits on viral suppression.
Results: A total of 1019 patients were evaluated in the study; 450 (44.2%) that met HSRA visit criteria and 569 (55.8%) who did not. A significant difference was observed for virologic suppression between the groups (94% vs 86%, p<0.0001). In comparison to PWH who did not meet the HRSA criteria, PWH who met HSRA visit criteria were 2.67 (95% Cl: 1.68-4.23) times more likely to have a viral load ≤50 copies/mL and 2.16 (95% Cl: 1.24-3.79) times after adjusting for sociodemographic, ART regimen and adherence, and other clinical characteristics. Factors found to be negatively associated with viral suppression were single marital status (aOR: 0.48; 95% CI: 0.24-0.94), current or historical opportunistic infection (aOR: 0.48; 95% CI: 0.24-0.94), and usage of a multiclass or dual ART regimen (aOR: 0.40; 95% CI: 0.16-0.98). On the contrary, positive factors included solely commercial insurance coverage (aOR: 2.40; 95% Cl: 1.00-5.79) and commercial insurance along with AIDS Drug Assistance Program (ADAP) coverage (aOR: 2.17; 95% Cl: 1.02-4.64).
Conclusion: Meeting HRSA visit criteria was significantly associated with virologic suppression in PWH.