Effects of a Laboratory Health Information Exchange Intervention on Antiretroviral Therapy Use, Viral Suppression, and Racial/Ethnic Disparities :

Abstract

<div class="section"> <a class="named-anchor" id="S1"> <!-- named anchor --> </a> <h5 class="section-title" id="d9229607e179">Background</h5> <p id="P1">Although antiretroviral therapy (ART) is available to treat HIV+ persons and prevent transmission, ineffective delivery of care may delay ART use, impede viral suppression (VS) and contribute to racial/ethnic disparities along the continuum of care. This study tested the effects of a bi-directional laboratory health information exchange (LHIE) intervention on each of these outcomes. </p> </div><div class="section"> <a class="named-anchor" id="S2"> <!-- named anchor --> </a> <h5 class="section-title" id="d9229607e184">Methods</h5> <p id="P2">We used a quasi-experimental, interrupted time series design to examine whether the LHIE intervention improved ART use and VS, and reduced racial/ethnic disparities in these outcomes among HIV+ patients (N=1,181) in a comprehensive HIV/AIDS clinic in Southern California. Main outcome measures included ART pharmacy fill and HIV VL lab data extracted from the medical records over three years. Race/ethnicity and an indicator for the intervention (after vs. before) were the main predictors. The analysis involved three-stage, multivariable logistic regression with generalized estimating equations (GEE). </p> </div><div class="section"> <a class="named-anchor" id="S3"> <!-- named anchor --> </a> <h5 class="section-title" id="d9229607e189">Results</h5> <p id="P3">Overall, the intervention predicted greater odds of ART use (OR=2.50; 95% CI=2.29-2.73; P&lt;0.001) and VS (OR=1.12; 95% CI=1.04-1.21; P&lt;0.05) in the final models that included sociodemographic, behavioral, and clinical covariates. Prior to the intervention, there were significant Black/White disparities in ART use OR=0.75 (0.58-0.98; P=0.04) and VS OR=0.75 (0.61-0.92; P=0.001). After the intervention, the Black/White disparities decreased after adjusting for sociodemographics and the number of HIV care visits, and Latinos had greater odds than Whites of ART use and VS, adjusting for covariates. </p> </div><div class="section"> <a class="named-anchor" id="S4"> <!-- named anchor --> </a> <h5 class="section-title" id="d9229607e194">Conclusions</h5> <p id="P4">The intervention improved overall ART treatment and VS, and reduced Black/White disparities. LHIE interventions may hold promise if implemented among similar patients. </p> </div>