Dataset Information

Evaluation of the revised versus original Ryan White Part A HIV Care Coordination Program in a cluster-randomized, stepped-wedge trial.

ABSTRACT:

Background

To address challenges with delivery of an evidence-based HIV care coordination program (CCP), the New York City (NYC) Health Department initiated a CCP redesign. We conducted a site-randomized stepped-wedge trial to evaluate effectiveness of the revised versus the original model.

Setting

The CCP is delivered in NYC hospitals, community health centers, and community-based organizations, to people experiencing or at risk for poor HIV outcomes.

Methods

The outcome, timely viral suppression (TVS), was defined as achievement of viral load <200 copies/mL within four months, among enrollees with unsuppressed viral load (≥200 copies/mL). Seventeen original-CCP provider agencies were randomized within matched pairs to early (August 2018) or delayed (May 2019) starts of revised-model implementation. Data from three periods were examined to compare revised versus original CCP effects on TVS. The primary analysis of the intervention effect applied fully conditional maximum likelihood estimation together with an exact, conditional P-value and an exact test-based 95% confidence interval (CI). We assigned each trial enrollee the implementation level of their site (based on a three-component measure), and tested for association with TVS, adjusting for period and study arm.

Results

Over three nine-month periods, 960 individuals were eligible for trial inclusion (intention to treat). The odds ratio of TVS versus no TVS comparing revised to original CCP was 0.88 (95%CI 0.45, 1.7). Thus, the revised program yielded slightly lower TVS, though the effect was statistically non-significant. TVS was not significantly associated with revised-CCP implementation level.

Conclusion

Program revisions did not increase TVS, irrespective of implementation level.

SUBMITTER: Irvine MK

PROVIDER: S-EPMC9936966 | biostudies-literature | 2022 Dec

REPOSITORIES: biostudies-literature

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Evaluation of the Revised Versus Original Ryan White Part A HIV Care Coordination Program in a Cluster-Randomized, Stepped-Wedge Trial.

Irvine Mary K MK Levin Bruce B Abdelqader Faisal F Carmona Jennifer J Avoundjian Tigran T Thomas Jacinthe J Braunstein Sarah L SL Robertson McKaylee M Nash Denis D

Journal of acquired immune deficiency syndromes (1999) 20221222 4

<h4>Background</h4>To address challenges with delivery of an evidence-based HIV care coordination program (CCP), the New York City Health Department initiated a CCP redesign. We conducted a site-randomized stepped-wedge trial to evaluate effectiveness of the revised versus the original model.<h4>Setting</h4>The CCP is delivered in New York City hospitals, community health centers, and community-based organizations to people experiencing or at risk for poor HIV outcomes.<h4>Methods</h4>The outcom ...[more]

PMID: 36729538

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