Comparable sustained virologic suppression between community- and academic-based HIV care settings

Area of Science:

• Infectious Diseases
• Public Health
• Health Services Research

Background:

• The human immunodeficiency virus (HIV) epidemic is evolving, with shifts in patient demographics and care delivery models.
• Provider shortages are necessitating changes in HIV care, potentially increasing the role of family medicine.
• Current HIV care is often concentrated in specialized settings, prompting an evaluation of alternative models.

Purpose of the Study:

• To compare the effectiveness of HIV treatment delivered in community-based versus academic hospital settings.
• To assess sustained virologic suppression rates as a primary outcome measure.

Main Methods:

• A cohort study of 15,047 HIV-infected adults from 2000-2008 across 13 sites (5 community, 8 hospital-based).
• Sustained virologic suppression defined as 2 consecutive HIV-1 RNA measurements ≤400 copies/mL within 1 year.
• Multivariate mixed effects logistic regression was used to control for confounding variables.

Main Results:

• Unadjusted analysis showed a significantly higher rate of sustained virologic suppression in community settings (71.1%) compared to hospital settings (66.1%).
• In the adjusted multivariate model, the rate remained higher in community settings (aOR 1.26), though not statistically significant.
• Community sites were primarily staffed by family medicine/general internal medicine, while hospital sites had infectious disease subspecialists.

Conclusions:

• Antiretroviral therapy can be effectively delivered in community-based settings.
• This finding supports the development of new programs to shift HIV care into community settings.
• Community-based care models are relevant given evolving accountable care, health reform, and funding landscapes.