title: Effects of a Laboratory Health Information Exchange Intervention on Antiretroviral Therapy Use, Viral Suppression, and Racial/Ethnic Disparities.
abstract: Although antiretroviral therapy (ART) is available to treat HIV+ persons and prevent transmission, ineffective delivery of care may delay ART use, impede viral suppression (VS), and contribute to racial/ethnic disparities along the continuum of care. This study tested the effects of a bi-directional laboratory health information exchange (LHIE) intervention on each of these outcomes.
  
  
  
  We used a quasi-experimental, interrupted time-series design to examine whether the LHIE intervention improved ART use and VS, and reduced racial/ethnic disparities in these outcomes among HIV+ patients (N = 1181) in a comprehensive HIV/AIDS clinic in Southern California. Main outcome measures were ART pharmacy fill and HIV viral load laboratory data extracted from the medical records over 3 years. Race/ethnicity and an indicator for the intervention (after vs. before) were the main predictors. The analysis involved 3-stage, multivariable logistic regression with generalized estimating equations.
  
  
  
  Overall, the intervention predicted greater odds of ART use (odds ratio [OR] = 2.50; 95% confidence interval: 2.29 to 2.73; P < 0.001) and VS (OR = 1.12; 95% confidence interval: 1.04 to 1.21; P < 0.05) in the final models that included sociodemographic, behavioral, and clinical covariates. Before the intervention, there were significant black/white disparities in ART use OR = 0.75 (0.58-0.98; P = 0.04) and VS OR = 0.75 (0.61-0.92; P = 0.001). After the intervention, the black/white disparities decreased after adjusting for sociodemographics and the number of HIV care visits, and Latinos had greater odds than whites of ART use and VS, adjusting for covariates.
  
  
  
  The intervention improved overall ART treatment and VS, and reduced black/white disparities. LHIE interventions may hold promise if implemented among similar patients.
authors.affiliation: *Division of General Internal Medicine and Health Services Research, Department of Medicine, School of Medicine, University of California, Los Angeles, CA; Departments of †Health Policy and Management; ‡Community Health Sciences, School of Public Health, University of California, Los Angeles, CA; and §St. Mary's Medical Center, Long Beach, CA.
authors.forename: William E
authors.initials: WE
authors.lastname: Cunningham
authors.forename: Chandra L
authors.initials: CL
authors.lastname: Ford
authors.forename: Janni J
authors.initials: JJ
authors.lastname: Kinsler
authors.forename: Danielle
authors.initials: D
authors.lastname: Seiden
authors.forename: Laral
authors.initials: L
authors.lastname: Andrews
authors.forename: Terry
authors.initials: T
authors.lastname: Nakazono
authors.forename: Douglas S
authors.initials: DS
authors.lastname: Bell
mesh_terms: D000328:Adult; D001741:Black or African American / Q000706:statistics & numerical data; D019380:Anti-HIV Agents / Q000627:therapeutic use*; D002140:California / Q000453:epidemiology; D003266:Continuity of Patient Care / Q000706:statistics & numerical data*; D003430:Cross-Sectional Studies; D005006:Ethnicity; D005260:Female; D015658:HIV Infections / Q000188:drug therapy* / Q000276:immunology; D066275:Health Information Exchange; D054624:Health Status Disparities; D054625:Healthcare Disparities / Q000208:ethnology; D006630:Hispanic or Latino / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D055118:Medication Adherence / Q000208:ethnology; D008875:Middle Aged; D016017:Odds Ratio; D019562:Viral Load / Q000706:statistics & numerical data*; D016903:Drug Monitoring
chemical_list: D019380:Anti-HIV Agents