Document Type

Capstone Experience

Graduation Date

12-2018

Degree Name

Master of Public Health

Department

Epidemiology

First Committee Member

Dr. Tricia D. LeVan

Second Committee Member

Dr. Gleb Haynatzki

Third Committee Member

Mr. Stephen G Jackson

Abstract

Abstract

Case management (CM) is one of the standard practices that has been implemented since 1990 to help people living with HIV/AIDS (PLWHA) in the United States. The program is designed for low-income populations and it aims to address the barriers related to access to health care and improve the HIV outcomes. Previous studies identified a positive association with the provision of CM and improvement in viral outcomes. Increasing the viral suppression rates among HIV diagnosed individuals proved to reduce the risk of transmitting the infection, and disease incidence. Although CM program is provided to Nebraskans diagnosed with HIV, but little is known about its effect on clients’ viral outcomes. Thus, we aimed to define the case managed population in Nebraska, addresses the impacts of CM on HIV outcomes, and identify risk factors associated with unimproved HIV outcomes.

Methods. We conducted a retrospective observational cohort study utilizing the Ryan White Provide© Case Management Database which contains the demographic information for all clients served, along with calendar dates of viral load tests and CD4+ cell counts. The primary outcome, viral load improvement (improved vs. not-improved), was computed based on the baseline and the last viral load results. Improved group included; 1) those who had suppressed viral load when entered into the CM and continue to be virally suppressed, and 2) those who entered with unsuppressed viral but developed suppression while they were in the CM program.

We analyzed the data for 385 subjects who had at least two viral load results available in the database and the last result was reported in the last three years (2016-2018.

Results: The overall viral suppression rate increased from 63% at baseline to 88% after enrollment, and only 45 out of 385 (11.7%) did not develop viral suppression. The lowest viral improvement observed among these groups who were female (26.8%), uninsured (15.2%), ≤ 40 years of age at baseline (46.2%), non-adherent to treatment (2.2%), and those who started the CM with a non-suppressed viral load (7.3%).

Conclusion. Case management programs serve predominantly low-economic population, yet we found the viral suppression rate increased remarkably among the CM clients after enrollment and it is relatively high compared to the national and state rates. However, in order to improve community’s health, we need to focus on certain minorities that had low viral suppression rates.

Keywords: case management, Ryan White, viral suppression, HIV/AIDS

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