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PLoS One. 2017 Jan 6;12(1):e0169246. doi: 10.1371/journal.pone.0169246. eCollection 2017.

Non-Communicable Disease Preventive Screening by HIV Care Model.

Author information

1
Division of General Internal Medicine, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania, United States of America.
2
Division of General Internal Medicine, Massachusetts General Hospital, Boston, Massachusetts, United States of America.
3
Harvard Medical School, Boston, Massachusetts, United States of America.
4
Division of Infectious Diseases, Massachusetts General Hospital, Boston, Massachusetts, United States of America.

Abstract

IMPORTANCE:

The Human Immunodeficiency Virus (HIV) epidemic has evolved, with an increasing non-communicable disease (NCD) burden emerging and need for long-term management, yet there are limited data to help delineate the optimal care model to screen for NCDs for this patient population.

OBJECTIVE:

The primary aim was to compare rates of NCD preventive screening in persons living with HIV/AIDS (PLWHA) by type of HIV care model, focusing on metabolic/cardiovascular disease (CVD) and cancer screening. We hypothesized that primary care models that included generalists would have higher preventive screening rates.

DESIGN:

Prospective observational cohort study.

SETTING:

Partners HealthCare System (PHS) encompassing Brigham & Women's Hospital, Massachusetts General Hospital, and affiliated community health centers.

PARTICIPANTS:

PLWHA age >18 engaged in active primary care at PHS.

EXPOSURE:

HIV care model categorized as infectious disease (ID) providers only, generalist providers only, or ID plus generalist providers.

MAIN OUTCOME(S) AND MEASURES(S):

Odds of screening for metabolic/CVD outcomes including hypertension (HTN), obesity, hyperlipidemia (HL), and diabetes (DM) and cancer including colorectal cancer (CRC), cervical cancer, and breast cancer.

RESULTS:

In a cohort of 1565 PLWHA, distribution by HIV care model was 875 ID (56%), 90 generalists (6%), and 600 ID plus generalists (38%). Patients in the generalist group had lower odds of viral suppression but similar CD4 counts and ART exposure as compared with ID and ID plus generalist groups. In analyses adjusting for sociodemographic and clinical covariates and clustering within provider, there were no significant differences in metabolic/CVD or cancer screening rates among the three HIV care models.

CONCLUSIONS:

There were no notable differences in metabolic/CVD or cancer screening rates by HIV care model after adjusting for sociodemographic and clinical factors. These findings suggest that HIV patients receive similar preventive health care for NCDs independent of HIV care model.

PMID:
28060868
PMCID:
PMC5218477
DOI:
10.1371/journal.pone.0169246
[Indexed for MEDLINE]
Free PMC Article

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