Health Information Programs Increase ART Uptake, Reduce Racial Disparities in HIV Care

The use of health information exchange interventions can improve overall antiretroviral therapy (ART) and viral suppression in patients with HIV, and reduce disparities in continuum of care between black and white patients, according to a recent study.

It is well documented that Blacks and Latinos are disproportionally affected by HIV, with socioeconomic and equity disparities placing these populations at a higher risk of infection. Furthermore, they are less likely to receive ongoing care than whites. According to the CDC, a 20-year-old gay black man has a 50% chance of contracting HIV in his lifetime.

In a study published in the Journal of Acquired Immune Deficiency Syndrome, the investigators sought to test the effects of bi-directional laboratory health information exchange (LHIE) intervention on ART and viral suppression.

The investigators used a quasi-experimental, interrupted time-series design to examine whether the LHIE intervention improved ART use and viral suppression, as well as reduced racial/ethnic disparities in these outcomes among HIV-positive patients from a Southern California HIV/AIDS clinic.

The primary outcomes were ART pharmacy fill and HIV viral load laboratory data obtained from the medical records over 3 years. Race/ethnicity and an indicator for the intervention were the main predictors. The analysis was made up of a 3-stage, multivariable logistic regression with generalized estimating equations.

The results of the study showed that the intervention predicted greater odds of ART use and viral suppression in the final models, which included sociodemographic, behavioral, and clinical covariates.

At the start of the study, blacks used ART approximately 25% less frequently than whites did and had 25% lower rates of viral suppression; however, the rates for both categories were equivalent by the end of the study.

Among Latinos, use of ART and viral suppression were equivalent to white patients at the start of the study. After the LHIE interventions, levels were 77% and 33% greater, respectively.

Overall, viral suppression in blacks and Latinos increased by 16% after implementation of the exchange.

“The intervention improved overall ART treatment and [viral suppression], and reduced black/white disparities,” the authors concluded. “LHIE interventions may hold promise if implemented among similar patients.”

According to the Office of the National Coordinator for Health Information Technology, HIE allows physicians, nurses, pharmacists, patients, and other health care providers to appropriately access and securely share a patients’ vital medical information electronically to improve the speed, quality, safety and cost of patient care.