Enhanced care coordination improves HIV viral load suppression rates

Area of Science:

• Public Health
• Infectious Disease Management
• Health Services Research

Background:

• Optimizing treatment for human immunodeficiency virus (HIV) infection is crucial for individual and community health.
• Health department HIV surveillance data linked with Medicaid managed care rosters can identify individuals with HIV who are not engaged in care or have unsuppressed viral loads.
• MetroPlus Health Plan, a Medicaid managed care organization, implemented targeted interventions to address these gaps.

Purpose of the Study:

• To evaluate the effectiveness of a 2-pronged approach involving street outreach and peer care connection interventions for optimizing HIV treatment.
• To identify and re-engage individuals with HIV infection who have unsuppressed viral loads or are unengaged in care.

Main Methods:

• A cohort study design was employed, collecting data on demographics, program contact type and frequency, antiretroviral therapy refill patterns, and HIV viral load and CD4 count.
• Members identified as not engaged in care (no viral load test in 9 months) received outreach.
• Members with unsuppressed viral loads received intensified care coordination and peer support.

Main Results:

• Out of 1429 targeted members, 82% were still enrolled in the plan.
• Street outreach achieved a 60% contact rate, while care coordination and peer support combined reached 40%.
• Contacted members showed a 44% viral load suppression rate (<200 copies/mL) and had a significantly greater likelihood of achieving viral load suppression (OR, 1.55; P <.01).

Conclusions:

• HIV surveillance data effectively targeted HIV-positive Medicaid members who were unsuppressed or disengaged.
• Intensified outreach, care coordination, and peer support facilitated by a Medicaid managed care plan can lead to viral load suppression in individuals with HIV.