title: Linkage, engagement, and viral suppression rates among HIV-infected persons receiving care at medical case management programs in Washington, DC.
abstract: BACKGROUND
  The District of Columbia Department of Health funds facilities to provide HIV medical case management (MCM), inclusive of linkage, engagement in care, and treatment adherence support. The objective of this analysis was to identify the differences in the clinical outcomes among HIV-infected persons receiving care at MCM-funded facilities compared with those in nonfunded facilities.
  
  
  METHODS
  Newly diagnosed and prevalent HIV-infected persons were identified from the District of Columbia Department of Health surveillance system. Clinical outcomes of interest were linkage, retention in care, and viral suppression. Bivariate analyses and random effects logistic regression were used to examine the differences in demographics and clinical outcomes of persons receiving care at MCM-funded and nonfunded facilities.
  
  
  RESULTS
  Among 5631 prevalent cases, 56.7% received care at MCM-funded facilities of which 76.2% were retained in care, and 70.6% achieved viral suppression. Those receiving care in MCM-funded facilities were significantly more likely to be retained in care [adjusted odds ratio (aOR) 4.13; 95% confidence interval (CI): 1.93 to 8.85] and as likely (aOR 1.06; 95% CI: 0.68 to 1.62) to be virally suppressed than persons receiving care in nonfunded facilities. Among 789 newly diagnosed persons, those diagnosed in MCM-funded facilities were not significantly more likely to be linked to care within 3 months (aOR 0.50; 95% CI: 0.21 to 1.18) than those diagnosed in nonfunded facilities.
  
  
  CONCLUSIONS
  This study provides evidence that MCM may be beneficial to HIV-infected persons in DC by improving retention in care. Further identification of the specific services providing the most benefit to clients is needed, including a better understanding of the complex relationship between retention and viral suppression.
authors: *The George Washington University School of Public Health and Health Services, Department of Epidemiology and Statistics, Washington, DC; and †District of Columbia Department of Health, HIV/AIDS, Hepatitis, STD, TB Administration, Washington, DC.
authors: Sarah
authors: S
authors: Willis
authors: Amanda D
authors: AD
authors: Castel
authors: Tashrik
authors: T
authors: Ahmed
authors: Christie
authors: C
authors: Olejemeh
authors: Lawrence
authors: L
authors: Frison
authors: Michael
authors: M
authors: Kharfen
mesh_terms: D044966:Anti-Retroviral Agents / Q000627:therapeutic use; D018791:CD4 Lymphocyte Count; D019090:Case Management / Q000191:economics; D003266:Continuity of Patient Care; D004219:District of Columbia; D005260:Female; D006678:HIV / Q000187:drug effects / Q000502:physiology; D015658:HIV Infections / Q000175:diagnosis / Q000188:drug therapy* / Q000453:epidemiology / Q000821:virology*; D006291:Health Policy / Q000191:economics; D006801:Humans; D008297:Male; D055118:Medication Adherence; D008875:Middle Aged; D011159:Population Surveillance; D015995:Prevalence; D015397:Program Evaluation; D019562:Viral Load
chemical_list: D044966:Anti-Retroviral Agents
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