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Different outcomes found between community, hospital-based clinics for HIV

SAN FRANCISCO — Outcomes for those with HIV differed according to whether they received care at hospital clinics or community-based clinics, according to data presented here at ID Week 2013.

“Outpatient care for people living with HIV is delivered in diverse settings,” Asher Schranz, MD, of New York University, said during his presentation. “Patient outcomes may be influenced by the type of clinic in which care is delivered.”

The researchers conducted a retrospective cohort study of patients with HIV who were receiving care at Ryan White-funded clinics in Philadelphia from 2008 to 2011. They evaluated the care setting and availability of onsite services, and also collected patient data for every patient during each 12-month period. The analysis included evaluations between clinic type and the following variables: retention in outpatient care, use of antiretroviral therapy and HIV viral suppression.

The clinics comprised 12 hospital clinics and 13 community-based clinics. During the 4-year period, 61% of the patients received care at hospital-based clinics. Females and patients with higher incomes were more likely to receive hospital-based care. Those with Medicare, Medicaid or no insurance were more likely to receive care at community-based clinics.

Among patients receiving hospital-based clinic care, 82% were retained in care, 87% used ART and 76% had HIV viral suppression, compared with 85%, 86% and 71%, respectively, of those receiving care in community-based clinics. After adjustment for patient and clinic factors, patients receiving hospital-based care had a lower retention in care (OR=0.78; 95% CI, 0.73-0.84). This group did not have a different rate of ART use (OR=1.06; 95% CI, 0.97-1.16) but achieved higher rates of HIV viral suppression (OR=1.24; 95% CI, 1.15-1.33).

Baligh Yehia 

Baligh Yehia

“Each type of clinic holds unique lessons for improving HIV outcomes,” Baligh Yehia, MD, assistant professor of medicine at the University of Pennsylvania and one of the study investigators, told Infectious Disease News. “HIV providers and clinic administrators should continue to learn from each other and from different models of care to provide the best patient care possible.”

Yehia said the next step is to gain a better understanding of what is happening within these clinics that led to the finding that community clinics had higher rates of retention in care while hospital-based clinics had higher rates of viral suppression.

For more information:

Schranz A. #77. Presented at: ID Week 2013; Oct. 2-6, 2013; San Francisco.

Disclosure: The researchers report no relevant financial disclosures.

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