Factors Associated with Increased Use of HIV-Related Care

ABSTRACT
Background: Despite a 42% decrease in newly diagnosed HIV cases from 2008-2012, Washington DC is still experiencing a severe HIV epidemic, with 2.5% of its population living with HIV (a rate exceeding the WHO epidemic definition of greater than 1% disease prevalence). The PP program assists community-based organizations/clinics that serve PLWHAs, in linking their clients with unmet health and non-health needs to appropriate services. At four time-points over a period of 18 months, the PP program assesses the clients’ clinical outcomes, number of medical visits, stigma experiences, unmet needs, and access & barriers to care.
Methods: The current study seeks to ascertain the relationship between completing the program (defined as undergoing all four assessments) and clients’ viral load suppression, healthcare utilization, stigma experience, most urgent unmet needs, and greatest barriers to care. All statistical analyses shall be conducted on the SAS platform (Cary, NC).
Results: N/A at this time.
Conclusions: N/A at this time.

BACKGROUND
Although the number of newly diagnosed HIV cases in Washington DC decreased 42% between 2008 to 2012, the percentage of people living with HIV (2.5%; N=16, 072) still exceeds the World Health Organization definition of 1% as a severe epidemic1. Moreover, men, African-Americans and African-American males represent those groups with higher rates of HIV/AIDS (3,905, 3,927 and 5,744 people, respectively, per 100,000 people).1 Prompt and sustained HIV-related medical care and support is crucial to achieving viral load suppression, resulting in better health outcomes for people living with HIV (PLWHs) 1, as well as reduced HIV transmission at the population level.2,3
Implemented in 2011, the PP program is a sub grantee of the AUA2C Initiative funded by a grant from the CNCS SIF. The program assists six community-based organizations/clinics that serve people living with HIV/AIDS (PLWHAs) in linking any clients that have unmet care needs with a prescribing physician and to other medical & supportive services. “Unmet care need” includes PLWHAs who are aware of their HIV status, but have received no HIV-related medical care in the last 12 months.
Community health workers (CHWs) based at these six organizations administer the PP program to their clients. The primary target population is PLWHAs residing in wards 5, 6, 7 and 8, as these wards are disproportionately affected by both HIV/AIDS and many social determinants of health disparities and poor health outcomes. For example, in 2012 wards 5, 6, 7 and 8 (which have proportions of Black residents ranging from 43% to 95%)4 reported the highest numbers of PLWHAs (2,752, 2,773, 2,692 and 3,058, respectively, per 100,000 population).1 From 2008-2012, injection drug use (IDU) and injection drug use among men who have sex with men (IDU/MSM) remained the 3rd and 4th highest mode of transmission for newly diagnosed HIV cases in the District, respectively.5
After enrolling eligible clients into the PP program (Intake Assessment), the CHWs subsequently interview participants at the 6-, 12- and 18-month marks. The data gathered during these assessments include the participant’s clinical outcomes, number of medical visits since the last assessment, unmet needs, and barriers to care that they have encountered.

SCOPE
As of January 21st 2015, the PP program had enrolled 889 eligible clients and conducted 3,141 distinct assessments. DGI was tasked with transferring the data from the program’s paper assessment forms into an electronic database, and ensuring data accuracy and completion. During the Culminating Experience (being conducted at DGI), these data will be analyzed to ascertain the impacts of the PP program on clients’ HIV outcomes, healthcare utilization, HIV-related stigma experience, access to pertinent needs, and barriers to care.

PRINCIPAL AIMS AND HYPOTHESES
The current study will seek to ascertain the impact of the PP program on clients’ HIV outcomes, healthcare utilization, HIV-related stigma experience, access to pertinent needs and barriers to care. Specifically, the study will investigate possible relationships between completing all four PP assessments and:
• Degree of viral load suppression
• Number of medical visits completed
• HIV-related stigma experience
• Access to HIV- and non HIV-related needs
• Most urgent unmet needs
• Decrease in barriers to HIV- and non HIV-related care
• Greatest barriers to care

METHODS (THIS IS THE SECTION THAT REQUIRES THE MOST WORK!)
Study Design: The current study will employ a cohort study design.
Data Sources: Identified data collected electronically on approximately 889 PP program participants.
Primary Independent Variable: Completion of the PP program, defined as having undergone all four of the program’s assessments.
Primary Dependent Variables: Viral Load Suppression, Number of Medical Visits, Extent of HIV Stigma Experience, Accessed Needs, Unmet Needs, Decreased Barriers to Care and Persistent Barriers to Care.
Statistical Analysis: All statistical analyses shall be conducted on the SAS platform (Cary, NC).
Human Subjects Protection: The current study shall seek full IRB approval before commencing; owing to the fact that, as part of her CE experience, Ms. Amana had access to identified PP data.

PUBLIC HEALTH IMPACT
From 2008 to 2012, the DC Department of Health reported increased linkage to HIV-related care (57.3% to 85.7%), increased viral load suppression (57.4% to 61.0%) and decreased late testing (56% to 44%) – all encouraging results of the District’s efforts to improve the care continuum and health outcomes of PLWHs1. The current study hopes to elucidate those areas where the PP program has had the greatest positive impact; this knowledge could serve to reinforce current continuity-of-HIV-care programs, and inform the implementation of future HIV/AIDS initiatives.

REFERENCES
1. District of Columbia Department of Health. Annual Epidemiology and Surveillance Report. December 2012.
2. Cohen MS, Chen YQ, McCauley M, et al. Prevention of HIV-1 Infection with Early Antiretroviral Therapy. N Eng J Med 2011;365(5):493-505
3. Das M, Chu PL, Santos, G-M, et al. Decreases in Community Viral Load Are Accompanied by Reductions in New HIV Infections in San Francisco. PLoS ONE 2010;5(6):e11068.
4. The Urban Institute & Washington DC Local Initiatives Support Corporation (LISC). DC 2012 Ward Profile. http://www.neighborhoodinfodc.org/wards/nbr_prof_wrd1.html. Revised April 2014. Accessed March 2015.
5. Centers for Disease Control and Prevention. HIV Surveillance Report, 2012; vol. 24. http://www.cdc.gov/hiv/library/reports/surveillance/. Published November 2014. Accessed January 2015.