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Impact of Multicomponent Support Strategies on Human Immunodeficiency Virus Virologic Suppression Rates During Coronavirus Disease 2019: An Interrupted Time Series Analysis.
Spinelli, Matthew A; Le Tourneau, Noelle; Glidden, David V; Hsu, Ling; Hickey, Matthew D; Imbert, Elizabeth; Arreguin, Mireya; Jain, Jennifer P; Oskarsson, Jon J; Buchbinder, Susan P; Johnson, Mallory O; Havlir, Diane; Christopoulos, Katerina A; Gandhi, Monica.
  • Spinelli MA; Department of Medicine, Division of HIV, Infectious Diseases, and Global Medicine, University of California, San Francisco, California, USA.
  • Le Tourneau N; Department of Medicine, Division of HIV, Infectious Diseases, and Global Medicine, University of California, San Francisco, California, USA.
  • Glidden DV; Department of Epidemiology and Biostatistics, University of California, San Francisco, California, USA.
  • Hsu L; San Francisco Department of Public Health, San Francisco, California, USA.
  • Hickey MD; Department of Medicine, Division of HIV, Infectious Diseases, and Global Medicine, University of California, San Francisco, California, USA.
  • Imbert E; Department of Medicine, Division of HIV, Infectious Diseases, and Global Medicine, University of California, San Francisco, California, USA.
  • Arreguin M; Department of Medicine, Division of HIV, Infectious Diseases, and Global Medicine, University of California, San Francisco, California, USA.
  • Jain JP; Department of Psychiatry, University of California, San Francisco, California, USA.
  • Oskarsson JJ; Department of Medicine, Division of HIV, Infectious Diseases, and Global Medicine, University of California, San Francisco, California, USA.
  • Buchbinder SP; Department of Epidemiology and Biostatistics, University of California, San Francisco, California, USA.
  • Johnson MO; San Francisco Department of Public Health, San Francisco, California, USA.
  • Havlir D; Department of Medicine, Division of Prevention Science, University of California, San Francisco, California, USA.
  • Christopoulos KA; Department of Medicine, Division of Prevention Science, University of California, San Francisco, California, USA.
  • Gandhi M; Department of Medicine, Division of HIV, Infectious Diseases, and Global Medicine, University of California, San Francisco, California, USA.
Clin Infect Dis ; 75(1): e947-e954, 2022 Aug 24.
Article in English | MEDLINE | ID: covidwho-1852995
ABSTRACT

BACKGROUND:

After coronavirus disease 2019 (COVID-19) shelter-in-place (SIP) orders, viral suppression (VS) rates initially decreased within a safety-net human immunodeficiency virus (HIV) clinic in San Francisco, particularly among people living with HIV (PLWH) who are experiencing homelessness. We sought to determine if proactive outreach to provide social services, scaling up of in-person visits, and expansion of housing programs could reverse this decline.

METHODS:

We assessed VS 24 months before and 13 months after SIP using mixed-effects logistic regression followed by interrupted time series (ITS) analysis to examine changes in the rate of VS per month. Loss to follow-up (LTFU) was assessed via active clinic tracing.

RESULTS:

Data from 1816 patients were included; the median age was 51 years, 12% were female, and 14% were experiencing unstable housing/homelessness. The adjusted odds of VS increased 1.34 fold following institution of the multicomponent strategies (95% confidence interval [CI], 1.21-1.46). In the ITS analysis, the odds of VS continuously increased 1.05 fold per month over the post-intervention period (95% CI, 1.01-1.08). Among PLWH who previously experienced homelessness and successfully received housing support, the odds of VS were 1.94-fold higher (95% CI, 1.05-3.59). The 1-year LTFU rate was 2.8 per 100 person-years (95% CI, 2.2-3.5).

CONCLUSIONS:

The VS rate increased following institution of the multicomponent strategies, with a lower LFTU rate compared with prior years. Maintaining in-person care for underserved patients, with flexible telemedicine options, along with provision of social services and permanent expansion of housing programs, will be needed to support VS among underserved populations during the COVID-19 pandemic.
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Full text: Available Collection: International databases Database: MEDLINE Main subject: Ill-Housed Persons / HIV Infections / COVID-19 Type of study: Cohort study / Experimental Studies / Observational study / Prognostic study Limits: Female / Humans / Male / Middle aged Language: English Journal: Clin Infect Dis Journal subject: Communicable Diseases Year: 2022 Document Type: Article Affiliation country: Cid

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Full text: Available Collection: International databases Database: MEDLINE Main subject: Ill-Housed Persons / HIV Infections / COVID-19 Type of study: Cohort study / Experimental Studies / Observational study / Prognostic study Limits: Female / Humans / Male / Middle aged Language: English Journal: Clin Infect Dis Journal subject: Communicable Diseases Year: 2022 Document Type: Article Affiliation country: Cid