Information exchange for patients with HIV reduces care disparity between blacks, whites
A laboratory health information exchange intervention, or LHIE, decreased the disparity in HIV care between black and white patients, according to researchers.
The intervention also improved overall ART use and viral suppression, they wrote in the Journal of Acquired Immune Deficiency Syndromes.
“These are important and unique findings because virtually no other intervention designed to improve overall HIV care has also helped reduce disparities in the outcomes,” they wrote. “The findings raise important questions about how to achieve the combined goals of (1) fostering ART delivery and adherence in order to suppress viral load for all patients while (2) reducing racial/ethnic disparities in ART use and viral suppression.”
William E. Cunningham, MD, MPH, professor of medicine and public health at the University of California, Los Angeles, and colleagues examined data for 1,181 patients with HIV treated at a Los Angeles-area clinic between December 2007 and November 2011. Overall, 22% of patients were black and 28% were Latino. Most patients (59%) were between the ages of 35 and 49 years.
The researchers developed the LHIE, which operated via an existing electronic medical records (EMR) system and integrated patient data on monthly ART use, prescription fills, viral suppression and viral load. Patient outcomes 2 years after the LHIE intervention was implemented were compared with those recorded 1 year before its initiation.
Overall, the odds of patients receiving ART more than doubled after intervention (adjusted OR = 2.50; 95% CI, 2.29-2.73).
In addition, before the intervention, blacks were less likely to receive ART than whites (OR = 0.75; 95% CI, 0.58-0.98). The disparity narrowed after the intervention (aOR = 0.83; 95% CI, 0.65-1.07). Latinos were more likely than whites to use ART after intervention (aOR = 1.77; 95% CI, 1.36-2.31).
The LHIE intervention was associated with an overall increase in viral suppression (aOR = 1.12; 95% CI, 1.04-1.21). Before intervention, blacks were less likely to achieve viral suppression (OR = 0.75; 95% CI, 0.61-0.92). That gap, too, narrowed after intervention (aOR = 0.85; 95% CI, 0.69- 1.05).
Latinos, after intervention, were more likely to achieve viral suppression than whites (aOR = 1.33; 95% CI, 1.11-1.59).
“This study provides evidence that a LHIE intervention can improve HIV care and health outcomes and reduce disparities in an urban HIV clinic population,” the researchers wrote. “Future research should assess its effectiveness in other populations and settings.”
Many of the same researchers published a similar study in the International Journal of Medical Informatics in 2012. They tested whether an LHIE intervention would result in a more rapid response to the need for ART regimen changes and improvements in communication between HIV–positive patients and their physicians about lab results. Among the same Los Angeles-area cohort, they compared outcomes from 2 years after the intervention with those 1 year before it.
A drop in CD4 cell count below 350 or 200 — or a viral load increase of a half log or to a value of more than 100,000 — would signal the need for an ART change. Among a total of 171 signals, the researchers said, the mean time from signal to ART change decreased from 37.7 days before the intervention to 31.4 days after (P = .03).
In addition, 65% of patients achieved undetectable viral loads by study’s end. Quicker response to signals for ART change were not associated, however, with undetectable viral loads.
On a 100-point scale, patients rated communication about their laboratory test results at 91 after the intervention, compared with 83 before. – by Joe Green