Effect of a multi-dimensional case management model on anti-retroviral therapy-related outcomes among people living with human immunodeficiency virus in Beijing, China

Lili Dai,Lijun Sun,Jiangzhu Ye,Shaoli Bai,Hao Wu,Xiaochun Yu,Jianyun Wang,An Liu,Bin Su,Taiyi Jiang,Yali Wang,Tong Zhang,Xiaoling Guo,Zaicun Li,Ying Shao,Sarah Robbins Scott

doi:10.1186/s12879-020-05219-9

Abstract

BackgroundThis paper introduces a comprehensive case management model uniting doctors, nurses, and non-governmental organizations (NGOs) in order to shorten the time from HIV diagnosis to initiation of antiviral therapy, improve patients’ adherence, and ameliorate antiretroviral treatment (ART)-related outcomes.MethodsAll newly diagnosed human immunodeficiency virus (HIV) cases at Beijing YouAn Hospital from January 2012 to December 2013 were selected as the control group, while all newly diagnosed HIV-infected patients from January 2015 to December 2016 were selected as the intervention group, receiving the comprehensive case management model.Results4906 patients were enrolled, of which 1549 were in the control group and 3357 in the intervention group. The median time from confirming HIV infection to ART initiation in the intervention group was 35 (18–133) days, much shorter than the control group (56 (26–253) days, P < 0.001). Participants in the intervention group had better ART adherence compared to those in the control group (intervention: 95.3%; control: 89.2%; p < 0.001). During the 2 years’ follow-up, those receiving case management were at decreased odds of experiencing virological failure (OR: 0.27, 95%CI: 0.17–0.42, P < 0.001). Observed mortality was 0.4 deaths per 100 patient-years of follow-up for patients in the control group compared with 0.2 deaths per 100 patient-years of follow-up in the intervention group.ConclusionsPeople living with HIV engaged in the comprehensive case management model were more likely to initiate ART sooner and maintained better treatment compliance and improved clinical outcomes compared to those who received routine care. A comprehensive case management program could be implemented in hospitals across China in order to reduce the HIV disease burden in the country.

Highlights

This paper introduces a comprehensive case management model uniting doctors, nurses, and nongovernmental organizations (NGOs) in order to shorten the time from Human immunodeficiency virus (HIV) diagnosis to initiation of antiviral therapy, improve patients’ adherence, and ameliorate antiretroviral treatment (ART)-related outcomes
According to the Joint United Nations Programme on HIV/acquired immune deficiency syndrome (AIDS) (UNAIDS), 37.9 million people were living with HIV (PLWH), 1.7 million people were newly infected with HIV, and 770,000 people died from AIDS related illness in 2018 [1]
Patients with higher CD4 cell counts were treated with ART when they made a special request to the providers [6]

Summary

Introduction

This paper introduces a comprehensive case management model uniting doctors, nurses, and nongovernmental organizations (NGOs) in order to shorten the time from HIV diagnosis to initiation of antiviral therapy, improve patients’ adherence, and ameliorate antiretroviral treatment (ART)-related outcomes. According to the Joint United Nations Programme on HIV/AIDS (UNAIDS), 37.9 million people were living with HIV (PLWH), 1.7 million people were newly infected with HIV, and 770,000 people died from AIDS related illness in 2018 [1] This is reflective of China’s epidemic as well, where new cases continue to be identified. In China, all people living with HIV are provided free ART therapy through the “Four Frees and One Care” program, which began in 2003 This program provided free ART mainly focus on PLWH whom had CD4 cell counts less than 200/μl in 2004, this changed to less than 350/μl in 2008 and less than 500/μl in 2014. Under current conditions of an absence of a vaccine or cure, “Rapid ART” can help control the HIV epidemic [12, 13]

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