Table 2.
HIV-specific and selected primary care outcomes across U.S. HIV care delivery models
| Study* | Mortality | HIV outcomes
|
Primary care outcomes | ||
|---|---|---|---|---|---|
| Retention | ART | HIV RNA suppression | |||
| Aiken 1993 | -- | -- | -- | -- | Difference in use of mental health services not statistically significant; more reported symptoms for patients of nurse practitioners vs. MDs (β=0.235, p=0.04) |
| Kitahata 1996 | Higher mortality among patients of least experience vs. most experience physicians (adjusted RR=0.69, 95% CI 0.59–0.80) | -- | Percentage of patients with AIDS on ART 59%, 49%, and 42% (most, moderate, and least experienced HIV clinicians) (p<0.001) | -- | -- |
| Laine 1998 | Decreased mortality for patients receiving care from high (>100 HIV patients) vs. low experience practices (<20 HIV patients) (53% decrease in relative hazard of death, 95% CI 0.35–0.82) | -- | No statistically significant difference for receiving ART by practice experience, 49.5% of patients overall receiving ART at baseline | -- | ‡ |
| Keitz 2001 | -- | No statistically significant difference in loss to follow-up among patients receiving care in general medicine clinic vs. infectious disease clinic | No statistically significant difference in number receiving ART by clinic type (80% in general medicine clinic vs. 76% in infectious disease clinic) | -- | More patients had TB screening in general medicine clinic (89%) than in infectious disease clinic (68%) (p=0.001) No statistically significant difference in pneumococcal vaccination across treatment groups |
| Gardner 2002 | -- | -- | Lower rates of guideline-concordant ART for patients with care from non-specialist HIV clinicians vs. patients receiving care from specialist HIV clinicians (p<0.001) | -- | Predictors of HIV specialist care are having depression (adjusted OR = 2.8, 95% CI 1.3–6.2) and current injection drug use (adjusted OR=0.4, 95% CI 0.1–0.95) |
| Kitahata 2003 | Higher risk of death among patients of least experienced physicians and who received infrequent primary primary care visits versus patients of most- experienced physicians (adjusted HR = 15.34 (95% CI 1.67–140.79)) | Patients of least and moderately experienced HIV physicians more likely to receive no primary or specialty care visits (adjusted OR=2.46, p<0.001) | -- | -- | Patients receiving care from more experienced physicians more likely to have a monthly primary care visit vs. patients of less experienced (adjusted OR = 0.50, 95% CI 0.32–0.77) and moderate experience physicians (adjusted OR=0.54, 95% CI 0.39–0.74) |
| Landon 2003 | -- | -- | Patients of non-HIV- specialist clinicians less likely to receive PI - based ART than those of infectious diseases specialists (adjusted OR=0.32, 95% CI 0.17–0.61) (findings attenuate) | -- | -- |
| Landon 2005 | -- | Percentage of patients with outpatient visits to infectious diseases physicians and HIV specialist primary care clinicians in last 3 quarters similar (both >65%) compared to 57% among non-HIV- specialist primary care clinicians (adjusted, p<0.01) | Probability of ART use for patients of infectious diseases specialists (0.83), HIV specialist primary care physicians (0.82) vs. non-HIV-specialist primary care clinicians (0.73) (p<0.05) | Probability of HIV RNA <400 copies/mL 0.41 (infectious diseases specialists), 0.39 (HIV specialist primary care clinicians), and 0.31 (non-HIV-specialist primary care clinicians) (p<0.01) | Probability of hepatitis C screening 0.86 (infectious diseases specialists), 0.81 (HIV specialist primary care clinicians), and 0.81 (non-HIV- specialist primary care clinicians) (results not statistically significant) Probability of influenza vaccination 0.54 (infectious diseases specialists), 0.49 (HIV- specialist primary care clinicians), and 0.41 (non-HIV- specialist primary care clinicians) (p<0.01) Probability of PPD testing and Pap smears not statistically different across clinician type |
| Irvine 2015 | -- | Percentage of previously diagnosed program clients engaged in care increased from 73.7% to 91.3% (relative risk=1.24, 95% CI 1.21 – 1.27)† | -- | Percentage of previously diagnosed program clients with HIV RNA <200 copies/mL increased from 32.3% to 50.9% (relative risk=1.58, 95% CI 1.50 – 1.66)† | -- |
| Young 2014 | -- | -- | -- | Higher proportion with complete HIV RNA suppression for patients with HIV care via telemedicine (91.1%) vs on-site (59.3%) (OR=7.0, 95% CI 5.1 – 9.8) | -- |
| Ding 2008 | -- | -- | Patients self-reporting no primary HIV care clinician less likely to receive ART vs. patients with care from a physician (adjusted, p=0.04) or an NP or PA (adjusted, p=0.012) | -- | Patients identifying a primary HIV care clinician less likely to receive care at sites with a mental health professional or substance abuse counselor available (p<0.01) |
| Chu 2010 | -- | -- | 178 (42%) patients with community-based HIV care and 237 (55%) patients receiving hospital-based HIV care initiated combination ART (statistical significance not reported) | Likelihood of HIV RNA <400 copies/mL for patients receiving community vs. hospital-based HIV care not statistically significant (adjusted OR=1.24, 95% CI 0.69–2.33) | -- |
| Lê 1998 | -- | -- | -- | Rate ratio of psychologist visits for patients receiving team- based care compared to usual care not statistically significant (rate ratio = 0.80, 95% CI 0.56–1.10) | |
Abbreviations: ART = antiretroviral therapy; PI = protease inhibitor; CI = confidence interval; HR = hazard ratio; OR = odds ratio.
*
Studies are grouped by care delivery model and, within each group, ordered by publication year.
†
Engagement in care was defined as ≥2 CD4 or viral load tests administered at least 90 days apart, with at least 1 test in each half of the 12-month enrollment period. The definition of viral load suppression was met if HIV RNA ≤200 copies/mL occurred at the most recent viral load test in the second half of the 12-month evaluation period.