Work

Successful Navigation of Human Immunodeficiency Virus (HIV) Care Transition After Clinic Closure

Year: 2016

Type: article

Abstract: Background. In 2013 St. George's Clinic, a county-hospital-based Ryan White clinic in Birmingham, Alabama, closed operations. Of the 814 HIV-infected patients receiving care at St. George's Clinic, most (n = 684) had a structured transfer to another Ryan White clinic at University of Alabama at Birmingham (UAB 1917 Clinic). We hypothesized that the clinic closure and transition of care may have adversely affected outcomes among these patients. Methods. We conducted a retrospective study of baseline characteristics and outcomes of St. George's patients attending a transition visit with a social worker and scheduled to see an HIV provider between 1 February 2013 and 31 January 2014 (transfer population) versus established 1917 clinic patients with at least 1 scheduled HIV provider visit in the same period (n = 1864). We used univariate and multivariable logistic regression to evaluate the association between transfer status and hospitalization/emergency room (ED) visit and viral suppression at 12 months. Results. Among 814 St. George's patients, 684 (84%) attended a transition visit. At baseline the transfer population had a higher proportion of women, African Americans, patients on public insurance, and in-county residence than established patients. Prevalence of active depression was also higher at baseline. There was a lower proportion of transfer patients with a HIV VL <200 copies/ml at baseline (71 versus 85%) (all p < 0.001). Although the proportion of transfer patients with UAB hospitalizations or ED visits was higher than for established patients (61 versus 46%), this difference was not significant after adjusting for baseline age, CD4 count, VL, obesity, depression, ongoing alcohol or substance abuse, active depression, and in-county residence (aOR 1.17; 95% CI, 0.93–1.46). We failed to identify a significance difference in the proportion of patients with viral suppression at 12 months between the populations (84 versus 90%; aOR 0.93; 95% CI, 0.63–1.37). Conclusion. With a structured clinic transition, HIV-infected patients transferring from a closing Ryan White clinic to another clinic in the same city appeared to have no higher odds of hospitalization/ED visit or virologic failure than established patients at the accepting clinic after accounting for baseline differences. Disclosures. All authors: No reported disclosures.

Source: Open Forum Infectious Diseases

DOI: 10.1093/ofid/ofw172.351