Lili Dai1, Xiaochun Yu2, Ying Shao1, Yali Wang1, Zaicun Li1, Jiangzhu Ye1, Shaoli Bai3, Xiaoling Guo3, Jianyun Wang3, Bin Su1, Taiyi Jiang1, Tong Zhang1, Hao Wu1, Sarah Robbins Scott4, An Liu5, Lijun Sun6. 1. Center for Infectious Diseases, Beijing Youan Hospital, Capital Medical University, Beijing, 100069, China. 2. School of Public Health, Anhui Medical University, Hefei, 230032, Anhui, China. 3. Lanzhou Municipality Pulmonary Hospital, Lanzhou, 730046, Gan Su, China. 4. The National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, 100037, China. 5. Center for Infectious Diseases, Beijing Youan Hospital, Capital Medical University, Beijing, 100069, China. liuan75@163.com. 6. Center for Infectious Diseases, Beijing Youan Hospital, Capital Medical University, Beijing, 100069, China. sunlijunkity@163.com.
Abstract
BACKGROUND: This 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. METHODS: All 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. RESULTS: 4906 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. CONCLUSIONS: People 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.
BACKGROUND: This 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. METHODS: All 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-infectedpatients from January 2015 to December 2016 were selected as the intervention group, receiving the comprehensive case management model. RESULTS: 4906 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. CONCLUSIONS:People 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.
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Keywords:
Case management; HIV; Retention rate; Virologic failure