Among the 19,199 people living with HIV (PLWH) in Philadelphia, 6,401 (33%) were out of care (OOC) in 2017. Engagement in care is integral to decreasing HIV transmission and achieving Ending the HIV Epidemic outcomes. This analysis aims to characterize persons OOC and assess outcomes of a collaborative health department/medical provider data-to-care randomized control trial.
OOC patients were randomized to Standard of Care (SOC) or Intervention, in which Disease Intervention Specialists assisted patients with reengagement. Criteria for inclusion were age >18, in-care at a participating clinic during a 12-month eligibility period and no care in the following 6 months. Chi-square testing was used to determine differences in demographics between study arms. Multivariable logistic regression was used to assess predictors of 3 outcomes: re-engagement (CD4/VL within 90 days), retention (2 or more CD4/VLs at least 90 days apart within 1 year) and viral suppression (VL <200 c/mL within 1 year).
449 OOC PLWH were randomized to each study arm between 8/2016-12/2017, with no significant differences in demographic characteristics between arms. The majority of patients were evenly distributed across age groups >25, 65% were Black, 76% were male, 42% were MSM, and 21% were HIV/non-AIDS at diagnosis. Across arms, 53% were re-engaged, 52% were retained at 1 year, and 60% were virally suppressed at 1 year. Patients randomized to the intervention were 2.22 (95% CI: 1.69-2.92), 1.89 (1.44-2.48) and 1.44 (1.10-1.90) times as likely as SOC patients to re-engage in care, become retained in care, and achieve viral suppression, respectively, when controlling for race, birth sex, age, transmission category and disease stage at diagnosis.
Results indicate that a collaborative data-to-care intervention can improve re-engagement in care, retention in care and viral suppression among PLWH who are OOC. Next steps include expansion of this model to determine feasibility of city-wide implementation.