Integrated HIV care is associated with improved engagement in treatment in an urban methadone clinic

Claire Simeone,Paula J Lum,Brad Shapiro

doi:10.1186/s13722-017-0084-y

Claire Simeone, Paula J Lum + Show 1 more

Open Access

https://doi.org/10.1186/s13722-017-0084-y

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Abstract

BackgroundPersons living with HIV and unhealthy substance use are often less engaged in HIV care, have higher morbidity and mortality and are at increased risk of transmitting HIV to uninfected partners. We developed a quality-improvement tracking system at an urban methadone clinic to monitor patients along the HIV care continuum and identify patients needing intervention.ObjectiveTo evaluate patient outcomes along the HIV Care Continuum at an urban methadone clinic and explore the relationship of HIV primary care site and patient demographic characteristics with retention in HIV treatment and viral suppression.MethodsWe reviewed electronic medical record data from 2015 for all methadone clinic patients with known HIV disease, including age, gender, race, HIV care sites, HIV care visit dates and HIV viral load. Patients received either HIV primary care at the methadone clinic, an HIV specialty clinic located in the adjacent building, or a community clinic. Retention was defined as an HIV primary care visit in both halves of the year. Viral suppression was defined as an HIV viral load <40 copies/ml at the last lab draw.ResultsThe population (n = 65) was 63% male, 82% age 45 or older and 60% non-Caucasian. Of these 65 patients 77% (n = 50) were retained in care and 80% (n = 52) were virologically suppressed. Viral suppression was significantly higher for women (p = .022) and patients 45 years or older (p = .034). There was a trend towards greater retention in care and viral suppression among patients receiving HIV care at the methadone clinic (93, 93%) compared to the HIV clinic (74, 79%) or community clinics (62, 62%).ConclusionsRetention in HIV care and viral suppression are high in an urban methadone clinic providing integrated HIV services. This quality improvement analysis supports integrating HIV primary care with methadone treatment services for this at-risk population.

Highlights

Persons living with human immunodeficiency virus (HIV) and unhealthy substance use are often less engaged in HIV care, have higher morbidity and mortality and are at increased risk of transmitting HIV to uninfected partners
Retention in HIV care and viral suppression are high in an urban methadone clinic providing integrated HIV services
According to the most recent published data for the United States, an estimated 86% of people living with HIV had been diagnosed, 40% were engaged in care, and 30% achieved viral suppression of HIV

Summary

Introduction

Persons living with HIV and unhealthy substance use are often less engaged in HIV care, have higher morbidity and mortality and are at increased risk of transmitting HIV to uninfected partners. Persons living with HIV and unhealthy substance use are often less engaged in HIV care, have higher morbidity and mortality and are at increased risk of transmitting. According to the most recent published data for the United States, an estimated 86% of people living with HIV had been diagnosed, 40% were engaged in care (defined as having had an HIV medical care visit during the four month sampling period), and 30% achieved viral suppression of HIV. Current global estimates indicate that 53% of people living with HIV are diagnosed, 41% are in care and 32% are virally suppressed [9,10,11] with persons who inject drugs identified as a key population for screening and treatment intervention

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