Effectiveness of a “Suppression Bundle” to improve HIV virologic suppression in an outpatient infectious disease clinic: a pilot implementation study

ABSTRACT

Despite effectiveness and accessibility of combined anti-retroviral therapy (cART), only 85% of people living with HIV (PLHIV) in the United States are virologically suppressed. Improving suppression is complex. Our objective was to consider unique factors in PLHIV with non-suppressed viral loads in clinic and improve the percentage of suppressed patients by implementing a “Suppression Bundle” consisting of three to five bundled interventions with the goal of improved suppression. Prior to the study, there were 567 HIV-positive patients receiving care in clinic. Of those, 89 had a measurable viral load (>40 copies/mL). In this pilot pre-post implementation, we focused on the 89 non-suppressed patients to (1) determine feasibility of implementing bundles and (2) increase the number of patients with suppressed viral loads pre- to post-intervention. Of non-suppressed patients, 65 were active in care immediately pre-intervention and participated in the pilot. At the completion of the 9-month intervention, 46 had viral loads <40 copies/mL, demonstrating substantial improvement with 70.1% of the previously non-suppressed patients achieving suppression. By considering unique patient factors, an individualized Suppression Bundle is acceptable, feasible, and may increase virally suppressed patients in an outpatient clinic. Next steps include determining whether suppression bundles can be implemented in differing practices.

KEYWORDS:

• HIV
• implementation
• care bundles
• viral suppression

Acknowledgements

The authors acknowledge Caitlin Lisk and the Ryan White team for assistance in developing care bundles, as well as the remainder of our clinic staff who helped with project implementation.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Additional information

Funding

There are no funding sources to declare. Groceries were provided by donations from faculty and staff in the Division of Infectious Diseases and the Department of Medicine.