The New York City HIV Care Coordination Program (CCP), funded through the federal Ryan White HIV/AIDS Program, combines multiple evidence-based strategies to support persons living with HIV (PLWH) who are newly diagnosed with HIV or have a recent history of poor HIV care outcomes.
In an NIH-funded study recently published in the journal PLOS ONE, CUNY SPH Distinguished Professor of Epidemiology Denis Nash and colleagues assessed the comparative effectiveness of the CCP by merging programmatic data on CCP clients with population-based surveillance data on all known New York City PLWH.
The CCP and non-CCP groups were matched on propensity for CCP enrollment within four baseline treatment status groups (newly diagnosed or previously diagnosed and either consistently unsuppressed, inconsistently suppressed or consistently suppressed). The researchers compared CCP to non-CCP proportions with viral load suppression at 12-month follow-up.
The study found that the CCP intervention had a small positive short-term effect on viral load suppression among newly diagnosed PLWH and those who were consistently virally unsuppressed in the year prior to the start of follow-up, suggesting the program has been effective at helping with initial hurdles to anti-retroviral treatment access and adherence. However, the absence of an effect among previously diagnosed persons with any HIV viral suppression in the year prior to enrollment suggests that the CCP has not surpassed ‘usual care’ as a support for maintaining medication adherence. The team concluded that efforts to refine CCP service delivery in NYC could include more focused enrollment among newly diagnosed and consistently unsuppressed PLWH. The researchers recommend that future studies assess longer-term outcomes, including sustained viral suppression, in this population and others with known barriers to HIV care and treatment.
“NYC Care Coordination clients have other major challenges in their life besides HIV,” Nash says. “More than 22 percent of them had unstable housing, 30 percent had low mental health functioning, and 15 percent reported recent hard drug use. Fifty percent had at least one of these barriers at the time of program enrollment. That the CCP has some benefits over usual care is encouraging. However, the modest effects we observed remind us that there is no silver bullet for such a vulnerable group, and that we need to continue to improve the program to try and make it more effective.”
The CUNY team, in partnership with the New York City Department of Health and Mental Hygiene (DOHMH), just received a second NIH grant to evaluate the impact of a revised and updated CCP model, as compared to the original CCP model and as compared to contemporaneous ‘usual care’ in NYC. The new project will also study the implementation of recent CCP model revisions and the potential for further program refinements, from the perspectives of clients and CCP service providers.
This work was supported by the National Institute of Mental Health of the National Institutes of Health [grant number R01 MH101028 to Dr. Denis Nash of the CUNY Institute for Implementation Science in Population Health and Dr. Mary Irvine of NYC DOHMH].
Nash D, Robertson MM, Penrose K, Chamberlin S, Robbins RS, Braunstein SL, Myers JE, Abraham B, Kulkarni S, Waldron L, Levin B, Irvine MK. Short-term effectiveness of HIV care coordination among persons with recent HIV diagnosis or history of poor HIV outcomes. PLOS ONE, September 24, 2018