Impact of an HIV Care Coordination Program on All-cause, HIV-related, and Non-HIV-related Mortality in Younger and Older Adults With HIV in New York City, 2018-2022.

BACKGROUND

Evidence-based strategies are needed to address the increasing healthcare system demands for people aging with HIV (PAWH). HIV case management models integrating access to primary care, specialty care, and supportive services represent a promising approach for healthy aging.

METHODS

We emulated a target trial comparing mortality outcomes through 36-month follow-up among people with HIV (PWH) enrolled in the New York City revised Care Coordination Program (CCR) versus a contemporaneous group of PWH who met CCR eligibility criteria but did not enroll in the CCR. To estimate the effect of the CCR on all-cause and cause-specific mortality, we used hazards regression with inverse probability of treatment weights controlling for clinical and demographic differences.

RESULTS

From August 2018 to March 2021, 3040 individuals enrolled in the CCR. At enrollment, 43% of CCR enrollees were aged 50 years or older, 27% had a CD4 count <200 cells/µL, and 19% were diagnosed prior to 1996. In adjusted analyses, CCR enrollees had lower all-cause mortality (adjusted hazard ratio [aHR]: 0.71 [0.60-0.84]), driven primarily by reductions in HIV-related deaths. The effects on all-cause and HIV-related mortality were consistent among PAWH and younger PWH, among those lacking evidence of viral suppression (VS), and among those with lower CD4 counts (<350 cells/µL).

CONCLUSIONS

The CCR appears to reduce all-cause and HIV-related mortality including among PWH at highest risk for poor outcomes. These findings suggest that integrated care coordination models-linking primary care, specialty care, and psychosocial services-offer survival benefits and multiple health outcomes improvements among PWH.