A cross-disciplinary coordinated HIV care program in Los Angeles County increased the probability that clinic patients would achieve viral suppression, but housing instability and other comorbidities dampened that success, researchers reported in Journal of Acquired Immune Deficiency Syndromes.
All 6,408 PLWH in the study were enrolled in the program because they met any of a range of criteria that suggested they were not solidly in the HIV care continuum, including having an unsuppressed viral load, going seven months or more without seeing an HIV medical provider, or being newly diagnosed with HIV. The intervention, called a Medical Care Coordination Program, involves teams that include a registered nurse, case worker, and a social worker with at least a master’s degree.
Overall, the likelihood of being virally suppressed rose from 0.35 to 0.77 during the first six months of program enrollment and was maintained for up to 36 months.
Care plans were individually tailored to address each participant’s specific needs; housing instability, stimulant use, and high depressive symptoms were all considered. Having one of these needs lowered the probability of viral suppression. However, after three years in the program, those with depressive symptoms had similar odds of viral suppression as participants without any comorbidity. (The same was not true for stimulant use or homelessness, however.)
The findings are consistent with a similar study in New York City, the study authors noted. Coordinated care programs help people achieve viral suppression, but people experiencing homelessness or taking stimulants need additional support, they concluded. They called for additional research to identify specific program components needed, and for targeted Ending the HIV Epidemic funds to help local health jurisdictions set up their own medical care coordination programs.