+ Site Statistics
+ Search Articles
+ PDF Full Text Service
How our service works
Request PDF Full Text
+ Follow Us
Follow on Facebook
Follow on Twitter
Follow on LinkedIn
+ Subscribe to Site Feeds
Most Shared
PDF Full Text
+ Translate
+ Recently Requested

HIV-infected patients and treatment outcomes: an equivalence study of community-located, primary care-based HIV treatment vs. hospital-based specialty care in the Bronx, New York



HIV-infected patients and treatment outcomes: an equivalence study of community-located, primary care-based HIV treatment vs. hospital-based specialty care in the Bronx, New York



Aids Care 22(12): 1522-1529



The HIV-infected population in the USA is expanding as patients survive longer and new infections are identified. In many areas, particularly rural/medically underserved regions, there is a growing shortage of providers with sufficient HIV expertise. HIV services incorporated into community-based (CB), primary care settings may therefore improve the distribution and delivery of HIV treatment. Our objective was to describe/compare patients and treatment outcomes in two settings: a community-located, primary care-based HIV program, and a hospital-based (HB) specialty center. CB providers had on-site access to generalist HIV experts. The hospital center was staffed primarily by infectious disease physicians. This was a retrospective cohort study of 854 HIV-positive adults initiating care between 1/2005 and 12/2007 within an academic medical center network in the Bronx, NY. Treatment outcomes were virologic and immunologic response at 16-32 and 48 weeks, respectively, after combination antiretroviral therapy (cART) initiation. We found that HB subjects presented with a higher prevalence of AIDS (59% vs. 46%, p<0.01) and lower initial CD4 (385 vs. 437, p<0.05) than CB subjects. Among 178 community vs. 237 hospital subjects starting cART, 66% vs. 62% achieved virologic suppression (95% confidence interval (CI) difference -0.14-0.06) and 49% vs. 59% achieved immunologic success, defined as a 100 cell/mm³ increase in CD4 (95% CI difference 0.00-0.19). The multivariate-adjusted likelihoods of achieving viral suppression [OR=1.24 (95% CI 0.69-2.33)] and immunologic success [OR=0.76 (95% CI 0.47-1.21)] were not statistically significant for community vs. hospital subjects. Because this was an observational study, propensity scores were used to address potential selection bias when subjects presented to a particular setting. In conclusion, HIV-infected patients initiate care at CB clinics earlier and with less advanced HIV disease. Treatment outcomes are comparable to those at a HB specialty center, suggesting that HIV care can be delivered effectively in community settings.

Please choose payment method:






(PDF emailed within 0-6 h: $19.90)

Accession: 053466285

Download citation: RISBibTeXText

PMID: 20824549

DOI: 10.1080/09540121.2010.484456


Related references

Collaborative care for the treatment of depression in primary care with a low-income, spanish-speaking population: outcomes from a community-based program evaluation. Primary Care Companion for Cns Disorders 14(6):, 2012

Implementation of stepped care for patients with chronic fatigue syndrome in community-based mental health care: outcomes at post-treatment and long-term follow-up. Behavioural and Cognitive PsychoTherapy 47(5): 548-558, 2019

Periodontal maintenance following active specialist treatment: Should patients stay put or return to primary dental care for continuing care? A comparison of outcomes based on the literature. International Journal of Dental Hygiene 16(1): 68-77, 2018

Primary versus specialty care outcomes for depressed outpatients managed with measurement-based care: results from STAR*D. Journal of General Internal Medicine 23(5): 551-560, 2008

What is next after transfer of care from hospital to home for stroke patients? Evaluation of a community stroke care service based in a primary care clinic. Journal of Neurosciences in Rural Practice 4(4): 413-420, 2013

Effects of hospital-based primary care setting on internists' treatment of primary care episodes. Health Services Research 16(4): 383-405, 1981

Shoulder pain patients in primary care--part 1: Clinical outcomes over 12 months following standardized diagnostic workup, corticosteroid injections, and community-based care. Journal of Rehabilitation Medicine 46(9): 898-907, 2014

Comorbidities, risk factors and outcomes in patients with heart failure and an ejection fraction of more than or equal to 40% in primary care- and hospital care-based outpatient clinics. Scandinavian Journal of Primary Health Care 36(2): 207-215, 2018

Nurse led, primary care based antiretroviral treatment versus hospital care: a controlled prospective study in Swaziland. Bmc Health Services Research 10: 229, 2010

Transitioning youths into care: linking identified HIV-infected youth at outreach sites in the community to hospital-based clinics and or community-based health centers. Journal of Adolescent Health 33(2 Suppl): 23-30, 2003

Comparing antiretroviral treatment outcomes between a prospective community-based and hospital-based cohort of HIV patients in rural Uganda. Bmc International Health and Human Rights 11(Suppl. 2): S12, 2011

A comparative analysis of treatment costs for home-based care and hospital-based care in enteral nutrition patients: A retrospective analysis of claims data. Health Policy 123(4): 367-372, 2019

Multimorbidity in patients enrolled in a community-based methadone maintenance treatment programme delivered through primary care. Journal of Comorbidity 4: 46-54, 2014

Antiretroviral treatment for HIV in rural Uganda: two-year treatment outcomes of a prospective health centre/community-based and hospital-based cohort. Plos one 7(7): E40902, 2012

Cv diagnosis and direct-acting antiviral agents -based treatment for Hiv/Hcv co-infected patients in a primary care setting in Maputo, Mozambique. International Journal of Infectious Diseases 73: 249-250, 2018