What is the Patient-Centered HIV Care Model?
In August 2014, the Centers for Disease Control and Prevention (CDC), Walgreens, the University of North Texas Health Science Center’s System College of Pharmacy, and HealthHIV implemented the Patient-Centered HIV Care Model (PCHCM). The goal of the model was to integrate community-based HIV-trained pharmacists with primary medical providers to provide patient-centered care for people with HIV and improve retention in HIV care, adherence to ART, and HIV viral suppression. The model was implemented at 10 project clinics and pharmacies.
What Do Data from the Model Tell Us?
Data from the model demonstrate how collaborations between community-based pharmacists and medical care providers can lead to improved outcomes for people with HIV. Research indicates that even when people with HIV receive care from multiple health care providers, they often receive all their medicines from one pharmacy, making the pharmacist a key point of contact. Therefore, collaborative efforts between properly trained community-based pharmacists and medical care providers are poised to play a unique and important role as we work together to identify and implement innovative strategies to end the HIV epidemic in America.
Retention in Care
Retention in care is a critical component of HIV prevention. Retention facilitates access to antiretroviral therapy (ART) and receipt of prevention and adherence counseling. Poor retention is associated with higher morbidity and mortality for persons with HIV and has significant implications for HIV transmission.
Data from the PCHCM show that, among participants, overall retention in care improved a relative 12.9%. The largest improvement (22.6% increase) was seen among non-Hispanic black persons. Persons who were non-Hispanic black, persons who received one or more pharmacist-clinic developed action plans, and persons who had three or more pharmacist encounters were more likely to be retained in care post-implementation. In the final models, only race/ethnicity (non-Hispanic black and "other or unknown" race/ethnicity) showed an association with post-implementation retention.
Recent scientific advances have shown that ART not only preserves the health, quality of life, and life expectancy of people with HIV, but people with HIV who take HIV medicine as prescribed and get and keep an undetectable viral load have effectively no risk of transmitting HIV to their HIV-negative sexual partners.
Data from the PCHCM showed that, pre- to post-model implementation, overall viral suppression improved a relative 15% (75% to 86%). Viral suppression improved within most demographic groups with notable improvements among privately insured persons (31% increase; 72% to 94%), persons whose care was covered by the Ryan White Program (23% increase; 65% to 80%), persons aged 25–34 years (26% increase; from 60% to 75%) and non-Hispanic black persons (23% increase; from 63% to 78%). The latter two improvements are particularly encouraging as younger adults have low viral suppression rates and studies have demonstrated persistent racial disparities related to viral suppression.
PCHCM Designated an Evidence-informed Intervention
The PCHCM was recently identified by CDC’s HIV/AIDS Prevention Research Synthesis Project as a best practice for Linkage to, Retention in, and Re-engagement in HIV Care, and Structural Interventions. The model will be listed in the Compendium of Evidence-Based Interventions and Best Practices for HIV Prevention.