title: Comparison of HIV outcomes for patients linked at hospital versus community-based clinics.
abstract: Outpatient care for people living with HIV is delivered in diverse settings. Differences in setting may impact HIV outcomes. We evaluated HIV-infected adults in care at Ryan White-funded clinics in Philadelphia, PA, between 2008 and 2011 to determine how setting of care (hospital versus community-based) influenced HIV outcomes. Clinics were categorized as hospital-based if they were located onsite at a hospital. The composite outcome was completion of the final three steps of the HIV care continuum: (1) retention in care; (2) use of antiretroviral therapy (ART); and (3) viral suppression. Mixed-effects logistic regression, accounting for patient and clinic factors, examined the relationship between care setting and the outcome. In total, 12,637 patients, contributing 32,515 patient-years, received care at 25 clinics (12 hospital-based). Women, non-Hispanic blacks, those with private insurance, and individuals with higher household incomes more commonly attended hospital-based clinics (p<0.05). Of the 12,962 patient-years (40%) during which patients attended community-based clinics, 59% met the outcome. Similarly, 59% of the 19,553 patient-years (60%) in which patients attended hospital-based clinics met the outcome. Adjusting for patient and clinic factors, setting was not associated with the outcome (adjusted odds ratio=1.24, 95% CI=0.84-1.84). In summary, demographics differ among patients visiting hospital and community-based clinics. Completion of the final three steps of the HIV care continuum did not vary between hospital and community-based clinics, which may reflect advances in HIV therapy and the wide availability of HIV care resources.
authors: 1 Department of Medicine, New York University School of Medicine , New York, New York.
authors: Asher J
authors: AJ
authors: Schranz
authors: Kathleen A
authors: KA
authors: Brady
authors: Florence
authors: F
authors: Momplaisir
authors: Joshua P
authors: JP
authors: Metlay
authors: Alisa
authors: A
authors: Stephens
authors: Baligh R
authors: BR
authors: Yehia
mesh_terms: D000293:Adolescent; D000328:Adult; D000553:Ambulatory Care / Q000379:methods; D019380:Anti-HIV Agents / Q000627:therapeutic use*; D023241:Antiretroviral Therapy, Highly Active / Q000379:methods; D003151:Community Health Centers; D003266:Continuity of Patient Care; D005260:Female; D015658:HIV Infections / Q000188:drug therapy*; D006302:Health Services Research; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D010044:Outpatient Clinics, Hospital; D015143:Philadelphia; D011787:Quality of Health Care / Q000706:statistics & numerical data; D012189:Retrospective Studies; D016896:Treatment Outcome; D014505:Urban Population; D055815:Young Adult
chemical_list: D019380:Anti-HIV Agents