HIV care cascade before and after hospitalization: impact of a multidisciplinary inpatient team in the US South

ABSTRACT

Hospitalization represents a unique opportunity to re-engage out-of-care individuals, improve HIV outcomes and reduce health disparities. Electronic health records of HIV-positive individuals hospitalized at an urban, public hospital between September 2013 and December 2015 were reviewed. In October 2014, a multidisciplinary HIV consult team (HIV specialist, case manager, and transitional care nurse (TCN)) was implemented. Engagement in care, retention in care and virologic suppression before and after hospitalization were compared between the pre- and post-intervention periods and by treatment received. Of 1056 inpatient admissions (pre-intervention = 571, post-intervention = 485), the majority were among males (69%) and racial/ethnic minorities (55% Black, 23% Hispanic). Each step of the HIV care cascade increased after hospitalization for both time periods (p < 0.01 for each comparison). Those who received the HIV consult (N = 131) or consult + TCN (N = 128) had greater increases in engagement in care (23.7% and 30.5% v. 11.1%, p = 0.04 and <0.01 respectively) and virologic suppression (28.3% and 29.7% v.7.1%, p <0.01 for both) than the no intervention (N = 225) subgroup. Hospitalized patients with HIV have low rates of engagement in care, retention in care and virologic suppression, though all three outcomes improved after hospitalization. A multidisciplinary transitions team improved care engagement and virologic suppression in those who received the intervention.

KEYWORDS:

• Hospitalization
• HIV care cascade
• transition of care
• retention

Acknowledgments

NIH K23 AI 112477, NIH R34 DA 045592, AHRQ R24 HS 022418

Disclosure statement

No potential conflict of interest was reported by the authors.

Additional information

Funding

AN receives research funding from the Gilead FOCUS program; Agency for Healthcare Research and Quality [grant number R24 HS 022418]; National Institute of Allergy and Infectious Diseases [grant number K23 AI 112477]; National Institute on Drug Abuse [grant number R34 DA 045592]