Table I:
Proportion of persons with HIV and mental health conditionsa who were retained in care and virally suppressed pre- and post-model implementation, by characteristic, Patient-centered HIV Care Model, 2014 – 2016, United States
| Retained in careb | HIV RNA <200 copies/mLc | |||||||||
|---|---|---|---|---|---|---|---|---|---|---|
| Characteristic | Total n (%d) | Baseline (n = 421) n (%) | Follow-up (n = 390) n (%) | % Changee | p-valuef | Baseline (n = 387) n (%) | Follow-up (n = 367) n (%) | % Changee | p-valuef | |
| Total | 453 (100) | 252 (60) | 265 (68) | 13 | 0.009 | 306 (79) | 329 (90) | 13 | <0.001 | |
| Age in Years | 18–24 | 9 (2) | 4 (57) | 4 (67) | 17 | 0.701 | 4 (50) | 6 (86) | 71 | 0.096 |
| 25–34 | 68 (15) | 37 (62) | 38 (69) | 12 | 0.353 | 35 (69) | 45 (82) | 19 | 0.106 | |
| 35–49 | 150 (33) | 83 (59) | 88 (68) | 15 | 0.115 | 92 (73) | 103 (87) | 19 | 0.001 | |
| ≥50 | 226 (50) | 128 (60) | 135 (68) | 13 | 0.076 | 175 (87) | 175 (94) | 9 | 0.008 | |
| Race/ethnicity | Black, non-Hispanic | 165 (36) | 94 (62) | 108 (75) | 21 | 0.007 | 91 (64) | 115 (84) | 32 | <0.001 |
| Hispanic | 54 (12) | 35 (69) | 32 (70) | 2 | 0.960 | 41 (85) | 43 (98) | 14 | 0.040 | |
| White, non-Hispanic | 130 (29) | 64 (54) | 60 (56) | 4 | 0.731 | 90 (86) | 94 (95) | 11 | 0.019 | |
| White, ethnicity unknown | 55 (12) | 30 (57) | 35 (67) | 19 | 0.210 | 48 (98) | 45 (92) | −6 | 0.088 | |
| Other/Unknown | 49 (11) | 29 (63) | 30 (73) | 16 | 0.272 | 36 (86) | 32 (84) | −2 | 0.708 | |
| Sex | Male | 323 (71) | 181 (61) | 187 (68) | 12 | 0.066 | 230 (83) | 246 (93) | 11 | <0.001 |
| Female | 120 (27) | 64 (56) | 71 (68) | 21 | 0.036 | 72 (71) | 76 (82) | 16 | 0.032 | |
| Transgender | 10 (2) | 7 (78) | 7 (70) | −10 | 0.768 | 4 (50) | 7 (88) | 75 | 0.087 | |
| Medical Insurance | Medicaid | 144 (32) | 78 (59) | 76 (63) | 6 | 0.500 | 89 (71) | 100 (86) | 20 | 0.005 |
| Medicare | 37 (8) | 22 (65) | 29 (91) | 40 | 0.028 | 24 (75) | 27 (90) | 20 | 0.030 | |
| Ryan White/ADAPg | 59 (13) | 32 (62) | 39 (80) | 29 | 0.023 | 33 (70) | 41 (84) | 19 | 0.093 | |
| Private Insurance | 39 (9) | 22 (60) | 23 (72) | 21 | 0.207 | 24 (86) | 29 (100) | 17 | 0.052 | |
| Multiple | 85 (19) | 38 (49) | 45 (58) | 20 | 0.242 | 65 (88) | 68 (97) | 11 | 0.026 | |
| Uninsured/Unknown | 89 (20) | 60 (68) | 53 (67) | −2 | 0.867 | 71 (88) | 64 (89) | 1 | 0.691 | |
| Category of diagnosis | Non-psychotic Disorderh | 397 (88) | 220 (60) | 227 (67) | 11 | 0.043 | 274 (80) | 294 (91) | 13 | <0.001 |
| Psychotic Disorderi | 56 (12) | 32 (59) | 38 (78) | 31 | 0.056 | 32 (70) | 35 (83) | 20 | 0.070 | |
| Baseline substance use diagnosisj | No | 386 (85) | 221 (62) | 225 (68) | 10 | 0.058 | 266 (82) | 278 (90) | 11 | <0.001 |
| Yes | 67 (15) | 31 (50) | 40 (68) | 36 | 0.036 | 40 (66) | 51 (86) | 32 | 0.001 | |
Persons were considered to have a mental health condition if they had a mental health diagnosis in the baseline clinic record or had filled ≥1 prescription for an antidepressant, antianxiety or antipsychotic medication in the pre-implementation period.
Retention in care was defined as ≥1 medical visit with a physician, nurse practitioner, or physician assistant, in each 6-month period of a 12-month measurement period with a minimum of 60 days between medical visits. Pre-implementation retention was measured during the 12 months leading up to and including the enrollment date and post-implementation retention was measured from one day after the enrollment date to 12 months forward.
Viral suppression was defined as an HIV viral load of <200 HIV RNA copies/mL at the last test in the 12–month measurement period. In the pre- and post-implementation periods, the last viral load test was the viral load result closest to and furthest from the first comprehensive medication review date, respectively.
Column percentage.
Relative percentage change.
P-values were calculated using log binomial regression with an interaction term for time (pre- and post-implementation) by demographic factor level.
ADAP = AIDS Drug Assistance Program.
Includes persons with either a diagnosis for a non-psychotic mental health condition in the baseline clinic record (adjustment disorder, anxiety disorder, bipolar disorder, depression, dysthymia, panic disorder or post-traumatic stress disorder) and persons who filled ≥1 antidepressant/antianxiety prescription in the pre-implementation period. Persons who had a diagnosis for both a psychotic disorder and a non-psychotic disorder or who had filled both an antipsychotic medication and an antidepressant/antianxiety were categorized as having a psychotic disorder.
Includes persons with a diagnosis for schizoaffective disorder, schizophrenia, schizophreniform disorder or psychotic disorder (not otherwise specified) in the baseline clinic record and persons who filled ≥1 antipsychotic medication in the pre-implementation period.
Includes persons with a mental health condition and a diagnosis of substance (alcohol or drug) use, abuse or dependence in the pre-implementation period.