The American journal of managed care · 2019
Enhanced care coordination improves HIV viral load suppression rates.
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Hewitt Ross G, Williams Debra, Adule Richard, Feldman Ira, Alsumidaie Moe
Аннотация
OBJECTIVES: Optimizing HIV treatment benefits the health of the individual and the community at large. Health department HIV surveillance data matched with Medicaid managed care rosters can be used to target people with HIV infection who have an unsuppressed viral load or are unengaged in care. MetroPlus Health Plan, a Medicaid managed care organization, implemented a 2-pronged approach: street outreach and peer care connection interventions.
STUDY DESIGN: A cohort study that included demographics, program contact type and frequency, antiretroviral therapy refill pattern, and CD4 count and HIV viral load values/ranges and dates.
METHODS: Members without a viral load test result during the prior 9 months (not engaged) received outreach, and those with unsuppressed viral loads received intensified care coordination and peer support. A retrospective statistical analysis was conducted on cohort members with sufficient viral load data. A subanalysis excluded members who had suppressed viral loads at baseline.
RESULTS: A total of 1429 (82%) members in the state cross-referenced list were still enrolled in the plan at study initiation. Successful contact with targeted members by outreach was 60% compared with 40% by care coordination and peer support combined. Members who were successfully contacted by the program had a 44% suppression rate (<200 copies/mL) and a greater likelihood of achieving viral load suppression (odds ratio, 1.55; 95% CI, 1.23-1.95; P <.01) than those who were not.
CONCLUSIONS: Surveillance data were successfully used to target HIV-positive Medicaid members who had an unsuppressed viral load or were unengaged in care. Individuals with an unsuppressed viral load can achieve suppression through intensified outreach, care coordination, and peer support by a Medicaid managed care plan.
STUDY DESIGN: A cohort study that included demographics, program contact type and frequency, antiretroviral therapy refill pattern, and CD4 count and HIV viral load values/ranges and dates.
METHODS: Members without a viral load test result during the prior 9 months (not engaged) received outreach, and those with unsuppressed viral loads received intensified care coordination and peer support. A retrospective statistical analysis was conducted on cohort members with sufficient viral load data. A subanalysis excluded members who had suppressed viral loads at baseline.
RESULTS: A total of 1429 (82%) members in the state cross-referenced list were still enrolled in the plan at study initiation. Successful contact with targeted members by outreach was 60% compared with 40% by care coordination and peer support combined. Members who were successfully contacted by the program had a 44% suppression rate (<200 copies/mL) and a greater likelihood of achieving viral load suppression (odds ratio, 1.55; 95% CI, 1.23-1.95; P <.01) than those who were not.
CONCLUSIONS: Surveillance data were successfully used to target HIV-positive Medicaid members who had an unsuppressed viral load or were unengaged in care. Individuals with an unsuppressed viral load can achieve suppression through intensified outreach, care coordination, and peer support by a Medicaid managed care plan.