Community-Based HIV Care for MSM, Transgender Women As Effective as Hospital-Based Care

Certain populations, including men who have sex with men (MSM) and transgender women are disproportionately affected by HIV. For individuals who also belong to a minority group and/or have a lower socioeconomic status, the affect can be even more severe.

Based on this knowledge, a team of investigators from the University of Illinois at Chicago set out to compare virologic failure among MSM and transgender women receiving HIV care at a community-based model with those receiving care at a hospital-based model. The team found that the community-based model was just as effective as the hospital-based model in providing care to these patients.

The findings of the retrospective cohort study were presented in a poster at IDWeek 2019.

The investigators analyzed data that was extracted from the electronic medical records of MSM and transgender women living with HIV and receiving treatment at 1 of 6 community clinics or at a hospital-based clinic in Chicago from 2010 to 2014. The main outcome of the research was cumulative probability of virologic failure (viral load >200 copies/ml), as measured in each semester of observation.

The team used multivariable Cox Proportional Hazards model in order to determine the association between community- and hospital-based models with virologic failure and adjusted for confounding variables.

Data was evaluated for 290 patients, 20 of whom (7%) were transgender women. In totally, 49% of the patients were receiving care at a community-based model. When compared to patients receiving care at the hospital-based model, the community-based patients were more likely to be African American (72% vs. 61%), uninsured (50% vs. 39%), and have a history of substance abuse (38% vs. 24%).

Despite these characteristics, there was no observed difference between the 2 groups in virologic failure (57% in community-based model vs. 52% in hospital-based model; HR_adj=1.1; 95% CI [confidence interval]: 0.8 — 1.6). However, individuals who were younger (HR_adj=4.0; 95% CI: 2.3 — 7.1), used alcohol (HR_adj=1.6; 95% CI: 1.1 — 2.2) and did not have insurance (HR_adj=1.7; 95% CI: 1.1 — 2.6) were more likely to have virologic failure, according to the abstract.

Based on the data, the investigators conclude that community-based models are just as effective as traditional hospital-based models in providing HIV care to MSM and transgender women. They also note that outreach and targeted case management likely played a role in the effectiveness of this model and that further study is needed.

The abstract, Virologic Failure in HIV Infected Men Who Have Sex With Men and Transgender Women Treated in a Community Based Model vs a Hospital Based Model, was presented in a poster session on Friday, October 4, 2019, at IDWeek 2019 in Washington DC.