Non-Communicable Disease Preventive Screening by HIV Care Model

Area of Science:

• Infectious Diseases
• Public Health
• Internal Medicine

Background:

• The Human Immunodeficiency Virus (HIV) epidemic increasingly involves a co-occurring burden of non-communicable diseases (NCDs), necessitating long-term management strategies.
• Optimal models for screening HIV-infected individuals for NCDs remain underexplored, particularly regarding cardiovascular disease (CVD) and cancer prevention.

Purpose of the Study:

• To compare the rates of NCD preventive screening in persons living with HIV/AIDS (PLWHA) across different HIV care models.
• To investigate whether primary care models involving generalists improve screening rates for metabolic/CVD and cancer compared to infectious disease (ID) specialist models.

Main Methods:

• A prospective observational cohort study was conducted within the Partners HealthCare System.
• The study included 1565 PLWHA aged over 18 receiving primary care.
• HIV care models were categorized into ID providers only, generalist providers only, or a combination of ID and generalist providers.

Main Results:

• No significant differences in screening rates for metabolic/CVD outcomes (hypertension, obesity, hyperlipidemia, diabetes) or cancers (colorectal, cervical, breast) were observed among the three HIV care models.
• While the generalist group showed lower odds of viral suppression, CD4 counts and ART exposure were similar across all models.
• Adjustments for sociodemographic, clinical covariates, and provider clustering did not alter the findings regarding screening rates.

Conclusions:

• HIV care model type did not significantly impact the rates of metabolic/CVD or cancer screening for PLWHA.
• These findings suggest that preventive healthcare for NCDs is comparable for individuals with HIV, irrespective of whether their care is managed by infectious disease specialists, generalists, or a combination.