SCIENTIFIC
Impact of a Ryan White Clinic on Statewide New HIV Infections
AUTHORS : Armaghan-e-Rehman Mansoor , MD
Arif R . Sarwari , MD
West Virginia University Department of Internal Medicine
INTRODUCTION
The Ryan White ( RW ) human immunodeficiency virus ( HIV )/ acquired immunodeficiency syndrome ( AIDS ) program is a comprehensive system of care for patients with HIV that encompasses clinical care , social services , and medication support . The program is administered by the Health Resources and Services Administration , which is overseen by the Department of Health and Human Services . 1 Under the RW program , funds are allocated for the provision of services for underinsured , uninsured , and low-income patients and families . Within the United States ( US ), more than 50 % of all people with HIV are reported to benefit from RW services . 2 , 3 Data is available that provides evidence of the effectiveness of this program in improving continuity of care for patients with HIV , maintaining patient engagement in RW clinical services , and increasing the use of combination antiretroviral therapy ( cART ). 4 Maintaining retention of care and viral suppression are important landmarks in the achievement of sustained viral suppression among HIV-positive patients , which in turn is a critical part of the treatment of HIV and prevention of new infection . 5 , 6 Data from the US includes the presence of a wide range of viral suppression rates amongst various jurisdictions , highlighting the need for further interventions to decrease HIV transmission .
To our knowledge , no studies have investigated the direct impact of RW clinical services on new HIV transmission in a service region . We report results from a 10-year retrospective review of an HIV clinical site in West Virginia ( WV ) receiving RW funds . Located at the West Virginia University ( WVU ) School of Medicine in Morgantown ,
ABSTRACT
INTRODUCTION The Ryan White ( RW ) program is a cohort of services for underinsured , uninsured , and lowincome patients with human immunodeficiency virus ( HIV ) infection . Although the RW program is known to enhance patient engagement and continuity of care , there are no studies that have investigated the direct impact of a RW clinic on statewide HIV transmission .
METHODS A retrospective review of 372 patients was undertaken at an HIV clinical site receiving RW funds in West Virginia ( WV ) in 2009-2019 . Demographics , comorbid conditions , and details regarding disease acquisition were noted . Instate transmission was measured as the proportion of patients with newly diagnosed HIV who self-reported HIV acquisition within WV . With high rates of viral suppression and patient retention in our clinic , our hypothesis was that this proportion should decrease over time .
RESULTS Despite maintaining a greater than 90 % retention of care and viral suppression rate over the study period , our data did not show a significant decline in the ratio of patients newly infected with HIV within WV over time ( 54.2 % at the beginning of the study period vs 58.6 % at the end , p-value 0.199 ).
CONCLUSION Our results show that maintenance of high retention of care and viral suppression rates in one RW clinical site did not significantly reduce in-state transmission of HIV . Additional studies are needed to determine if maintaining high engagement in clinical services and sustained viral suppression across all HIV providers can reduce spread of in-state HIV infection .
WV , this clinic serves a catchment area for 33 counties . The location of the clinic is also in close proximity to three other states ( Pennsylvania , Maryland , and Ohio ). WV has one additional RW clinical site located in Charleston . The Charleston site includes a different service area , covering the central and southern region of WV as noted in Figure 1 . The site in Morgantown provides clinical services for approximately 50 % of all RW patients in the state , thus rendering it a key component of HIV clinical services . Given the position of the Morgantown RW clinical site for HIV care within WV , our primary aim was to determine the effect of providing holistic HIV clinical services on new HIV transmission within the state . We hypothesized that by providing HIV clinical services in this region and maintaining high rates of retention and viral suppression , new transmission from within the service area would decline . Our secondary aim was to determine if there were any differences in risk factors for HIV transmission as well as reported comorbid conditions between patients infected outside of WV and hence the service region , compared to those infected within the region .
MATERIALS AND METHODS
A retrospective review of electronic medical records for patients enrolled at the RW clinical site in Morgantown , WV , between January 1 , 2009 , and September 31 , 2019 , was performed . For each patient , the electronic chart was reviewed to determine reported place of infection based on provided demographic details and a review of risk factors and social history by a service provider . This information was collected for all patients at the time of clinic enrollment . The electronic chart was also queried for reported infectious and non-infectious comorbidities at the time of data collection using a combination of chart review , ICD codes , and laboratory results . A chronic infectious comorbid factor included in the study was a diagnosis of Hepatitis B or C . Non-infectious comorbid factors included hypertension , congestive
24 • www . wvsma . org