Effect of a Multidisciplinary Intervention for Early ART Initiation for Inpatients with Newly Diagnosed HIV

Abstract Background Antiretroviral therapy (ART) is recommended for all HIV patients. However, significant attrition occurs between HIV diagnosis and ART initiation especially among indigent populations. The purpose of this study was to evaluate the outcomes after the implementation of a multidisciplinary intervention for early ART initiation (EAI) for patients with HIV in a southern inner city hospital, Grady Memorial Hospital (GMH) in May 2016. Methods This is a single center, retrospective chart review with 6-month follow up of patients who were admitted to GMH from 1/1/15 to 9/30/16 and were either newly diagnosed with HIV and ART naïve at admission or diagnosed previously and not on ART at the time of admission. The outcomes are proportion initiated on ART in hospital, proportion enrolled at the clinic, proportion attending a provider’s visit within 30 days of hospital discharge and proportion achieving viral suppression (VS) within 6 months of hospital discharge before and after implementation of EAI. Bivariate analysis compared pre-EIA to post-EIA groups, using Chi-square or Fisher exact tests for categorical and Wilcoxon rank-sum test for continuous variables. Results The study included 109 patients: 86 pre-EAI vs 23 post-EAI. Baseline (BL) characteristics in the pre- vs post-EIA groups include: 68 (79.1%) vs. 17 (73.9%) male, 75 (87.2%) vs. 18 (78.3%) black, 57 (67.1%) vs. 12 (52.2%) uninsured. Median BL viral load was 138,340 vs. 103,955 copies/mL; median BL CD4+ cell count was 127 vs. 243 cells/mL respectively. During hospitalization, 17 (19.8%) vs. 9 (39.1%) were started on ART (P = 0.0529), 36 (41.9%) vs. 15 (65.2%) were enrolled (P = 0.0461) in HIV care, 23 (26.7%) vs. 14 (60.9%) attended an appointment (P = 0.0021), and 38 (44.2%) vs. 21 (52.2%) achieved VS (P = 0.7833). The median time to first appointment was 35 vs. 12 days (P = 0.0088) in the pre-EAI and post-EAI groups, respectively. Conclusion Implementation of the EAI program showed a trend toward increased rate of patients started on ART while inpatient, a significantly greater enrollment and first appointment within 30 days, and a significantly shorter time to establishing care. The majority of newly diagnosed HIV patients are still discharged without ART, therefore further work is needed to increase uptake of the program. Disclosures M. Patel, ViiV: Scientific Advisor, Consulting fee