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AIDS Patient Care STDS. 2019 Feb;33(2):58-66. doi: 10.1089/apc.2018.0216. Epub 2019 Jan 16.

Retention in HIV Care Among Participants in the Patient-Centered HIV Care Model: A Collaboration Between Community-Based Pharmacists and Primary Medical Providers.

Author information

1
1 Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia.
2
2 University of North Texas Health Science System College of Pharmacy, Fort Worth, Texas.
3
3 Walgreen Co., Deerfield, Illinois.
4
4 HealthHIV, Washington, District of Columbia.
5
5 ICF, Atlanta, Georgia.
6
6 Department of Biostatistics and Epidemiology, University of North Texas Health Science Center, Fort Worth, Texas.

Abstract

Poor retention in HIV care is associated with higher morbidity and mortality and greater risk of HIV transmission. The Patient-Centered HIV Care Model (PCHCM) integrated community-based pharmacists with medical providers. The model required sharing of patient clinical information and collaborative therapy-related action planning. The proportion of persons retained in care (≥1 medical visit in each 6-month period of a 12-month measurement period with ≥60 days between visits), pre- and post-PCHCM implementation, was modeled using log binomial regression. Factors associated with post-implementation retention were determined using multi-variable regression. Of 765 enrolled persons, the plurality were male (n = 555) and non-Hispanic black (n = 331), with a median age of 48 years (interquartile range = 38-55); 680 and 625 persons were included in the pre- and post-implementation analyses, respectively. Overall, retention improved 12.9% (60.7-68.5%, p = 0.002). The largest improvement was seen among non-Hispanic black persons, 22.6% increase (59.7-73.2%, p < 0.001). Persons who were non-Hispanic black [adjusted risk ratio (ARR) 1.27, 95% confidence interval (CI) 1.08-1.48] received one or more pharmacist-clinic developed action plan (ARR 1.51, 95% CI 1.18-1.93), had three or more pharmacist encounters (ARR 1.17, 95% CI 1.05-1.30), were more likely to be retained post-implementation. In the final multi-variable models, only race/ethnicity [non-Hispanic black (ARR 1.27, 95% CI 1.09-1.48) and "other or unknown" race/ethnicity (ARR 1.36, 95% CI 1.14-1.63)] showed an association with post-implementation retention. PCHCM demonstrated how collaborations between community-based pharmacists and primary medical providers can improve retention in HIV care. This care model may be particularly useful for non-Hispanic black persons who often are less likely to be retained in care.

KEYWORDS:

HIV; care continuum; pharmacists; retention

PMID:
30648888
PMCID:
PMC6379900
[Available on 2020-02-01]
DOI:
10.1089/apc.2018.0216
[Indexed for MEDLINE]

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