Care engagement and viral load suppression significantly improved after enrollment in an urban comprehensive HIV care coordination program, according to a study published in Clinical Infectious Diseases.
Previous studies had estimated that somewhere between 24% to 43% of those diagnosed with HIV are virally suppressed (defined as a viral load of < 200 copies/mL). By contrast, viral suppression was achieved by 66.2% of the 465 newly diagnosed clients enrolled in New York City's Ryan White Part A HIV Care Coordination Program (CCP). Additionally, the percentage of previously diagnosed clients enrolled in the program (3,176) who were virally suppressed increased from 32.2% to 50.9%.
Similarly, previously diagnosed clients' engagement in care (defined as at least two HIV tests 90 days apart, one or more tests during each half year) increased from 73.7% to 91.3%, while 90.5% of newly diagnosed clients met the criteria for engagement in care. The biggest improvement in both measures came from clients who had not been in HIV care for six months or more prior to enrolling in CCP.
Compared to the 70,823 HIV-infected New Yorkers who were not enrolled in the program during the same period (but who did receive medical care at some point during that time), CCP clients were more likely to be persons of color (91.5% in the CCP group versus 77.7% in the general HIV population) and female (37.2% versus 29.5%). Fewer of the CCP clients were virally suppressed at baseline compared to HIV-infected individuals who were not CCP clients (29.4% versus 46.7%).
Pre- and post-enrollment comparisons of engagement in care among CCP clients "suggest a higher potential impact among low-income, uninsured, unstably housed, and younger populations," according to the study authors.
Program enrollment also appeared to have "a higher potential impact for those with lower CD4 [counts], unsuppressed VL [viral load], and/or no current prescription for ART [antiretroviral therapy] at enrollment," the authors concluded.