Year of Publication

2016

College

Public Health

Degree Name

Master of Public Health (M.P.H.)

Committee Chair

Julia Costich, J.D., Ph.D.

Committee Member

Richard C. Ingram, DrPH

Committee Member

Sarah Wackerbarth, Ph.D.

Abstract

Ambulatory clinical healthcare settings that serve patients infected with the human immunodeficiency virus (HIV) are critical in improving access to quality HIV care and treatment, in part due to their ability to streamline patient care along the HIV care continuum. Barriers to HIV care are significant among newly diagnosed HIV patients and in order to engage and retain these individuals in care and treatment, specific interventions must be in place to link these individuals to care. In this study, the difference in differences method was used for data analysis to measure the impact of an ambulatory clinics intervention on their newly diagnosed HIV patients in an effort to improve their retention in care and HIV viral load suppression. The study participants all received their HIV specific care and treatment solely at the University of Kentucky, Department of Infectious Diseases HIV/AIDS Clinical Program (IMDP) that is a Ryan White HIV/AIDS program funded ambulatory clinic. Of the 1,156 patients enrolled in the IMDP clinic during the study, only 178 met the criteria for inclusion in the study. This retrospective cohort study included data extracted from 178 patients’ electronic health records over a 24-month period, with 96 patients in the first 12-month cohort and 82 patients in the second 12-month cohort. The differences in means from the two data sets were analyzed for significance using the Kolmogorov Smirnov two-sample test (KS) and p-value. The length of time between readings of the biomarkers viral load and CD4+ T-lymphocyte cell count at attended provider visits was statistically significant, suggesting that clients exposed to the intervention with these readings less than 90 days apart were more likely to have the recommended number of provider visits in a 12-month period more than 90 days apart. No significant differences in visit spacing means were found when controlling for viral load or CD4+ T-lymphocyte cell count. Additionally, each cohort’s mean differences showed a positive trend towards decreased viral load and increased CD4+ T-Lymphocyte cell count. Overall, this study provided empirical evidence for more consideration towards implementing HIV clinical interventions within large ambulatory clinical health systems that improve health outcomes and retention in care for newly diagnosed HIV patients.

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