title: Improvements in HIV care engagement and viral load suppression following enrollment in a comprehensive HIV care coordination program.
abstract: BACKGROUND
  Substantial evidence gaps remain regarding human immunodeficiency virus (HIV) intervention strategies that improve engagement in care (EiC) and viral load suppression (VLS). We assessed EiC and VLS before and after enrollment in a comprehensive intervention for persons at risk of poor HIV care outcomes.
  
  
  METHODS
  New York City's Ryan White Part A HIV Care Coordination Program (CCP), launched at 28 agencies in 2009, applies multiple strategies to promote optimal utilization of medical and social services. Using laboratory test records from an HIV surveillance registry, we examined pre-post outcomes among 3641 CCP clients enrolled before April 2011. For the year before and after enrollment, we assessed EiC (defined as ≥2 tests, ≥90 days apart, with ≥1 in each half-year) and VLS (defined as viral load [VL] ≤200 copies/mL on latest VL test in the second half of the year). We estimated relative risks (RRs), comparing pre- and postenrollment proportions achieving EiC and VLS.
  
  
  RESULTS
  Among newly diagnosed clients, 90.5% (95% confidence interval [CI], 87.9%-93.2%) and 66.2% (95% CI, 61.9%-70.6%) achieved EiC and VLS, respectively. Among previously diagnosed clients, EiC increased from 73.7% to 91.3% (RR = 1.24; 95% CI, 1.21-1.27) and VLS increased from 32.3% to 50.9% (RR = 1.58; 95% CI, 1.50-1.66). Clients without evidence of HIV care during the 6 months preenrollment contributed most to overall improvements. Pre-post improvements were robust, retaining statistical significance within most sociodemographic and clinical subgroups, and in 89% (EiC) and 75% (VLS) of CCP agencies.
  
  
  CONCLUSIONS
  Clients in comprehensive HIV care coordination for persons with evident barriers to care showed substantial and consistent improvement in short-term outcomes.
authors.affiliation: Bureau of HIV/AIDS Prevention and Control, New York City Department of Health and Mental Hygiene.
authors.forename: Mary K
authors.initials: MK
authors.lastname: Irvine
authors.affiliation: Bureau of HIV/AIDS Prevention and Control, New York City Department of Health and Mental Hygiene.
authors.forename: Stephanie A
authors.initials: SA
authors.lastname: Chamberlin
authors.affiliation: Bureau of HIV/AIDS Prevention and Control, New York City Department of Health and Mental Hygiene.
authors.forename: Rebekkah S
authors.initials: RS
authors.lastname: Robbins
authors.affiliation: Bureau of HIV/AIDS Prevention and Control, New York City Department of Health and Mental Hygiene Division of Infectious Diseases, Department of Medicine, Columbia University Medical Center.
authors.forename: Julie E
authors.initials: JE
authors.lastname: Myers
authors.affiliation: Bureau of HIV/AIDS Prevention and Control, New York City Department of Health and Mental Hygiene.
authors.forename: Sarah L
authors.initials: SL
authors.lastname: Braunstein
authors.affiliation: Bureau of HIV/AIDS Prevention and Control, New York City Department of Health and Mental Hygiene.
authors.forename: Beau J
authors.initials: BJ
authors.lastname: Mitts
authors.affiliation: Bureau of HIV/AIDS Prevention and Control, New York City Department of Health and Mental Hygiene.
authors.forename: Graham A
authors.initials: GA
authors.lastname: Harriman
authors.forename: Fabienne
authors.initials: F
authors.lastname: Laraque
authors.affiliation: School of Public Health Hunter College, The City University of New York, New York.
authors.forename: Denis
authors.initials: D
authors.lastname: Nash
mesh_terms: D000328:Adult; D000368:Aged; D018791:CD4 Lymphocyte Count; D015331:Cohort Studies; D003191:Comprehensive Health Care / Q000379:methods / Q000706:statistics & numerical data; D005260:Female; D015658:HIV Infections / Q000175:diagnosis* / Q000188:drug therapy* / Q000276:immunology / Q000821:virology; D006801:Humans; D008297:Male; D008875:Middle Aged; D009519:New York City / Q000453:epidemiology; D011635:Public Health Administration / Q000379:methods; D012189:Retrospective Studies; D016896:Treatment Outcome; D019562:Viral Load; D055815:Young Adult
keywords: Ryan White; implementation science; intervention effectiveness; outcomes evaluation; public health surveillance