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Author Topic: Gaps Up To 9 Months Between HIV Primary Care Visits  (Read 702 times)

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Online JimDublin

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Gaps Up To 9 Months Between HIV Primary Care Visits
« on: May 15, 2018, 02:18:50 pm »
Well the cohort looking into this, found 9 months gap 10% or fewer patients who lost viral suppression. ≥12 months gap, it was in 23% of patients.

Suitable for some prehaps not for others? Personally ill be sticking to 6 months guidelines for now as I don't mind the check up and besides its good to know my general health is okay besides just the HIV & VL


Current guidelines specify that visit intervals with viral monitoring should not exceed 6 months for HIV patients. Yet, gaps in care exceeding 6 months are common. In an observational cohort using US patients, we examined the association between gap length and changes in viral load status and sought to determine the length of the gap at which significant increases in viral load occur. We identified patients with gaps in care greater than 6 months from 6399 patients from six US HIV clinics. Gap strata were >6 to <7, 7 to <8, 8 to <9, 9 to <12, and ≥12 months, with viral load measurements matched to the opening and closing dates for the gaps. We examined visit gap lengths in association with two viral load measurements: continuous (log10 viral load at gap opening and closing) and dichotomous (whether patients initially suppressed but lost viral suppression by close of the care gap). Viral load increases were nonsignificant or modest when gap length was <9 months, corresponding to 10% or fewer patients who lost viral suppression. For gaps ≥12 months, there was a significant increase in viral load as well as a much larger loss of viral suppression (in 23% of patients). Detrimental effects on viral load after a care gap were greater in young patients, black patients, and those without private health insurance. On average, shorter gaps in care were not detrimental to patient viral load status. HIV primary care visit intervals of 6 to 9 months for select patients may be appropriate.

AIDS Patient Care STDS. 2018 Apr;32(4):157-164. doi: 10.1089/apc.2018.0001.
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Online leatherman

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Re: Gaps Up To 9 Months Between HIV Primary Care Visits
« Reply #1 on: May 16, 2018, 12:22:08 pm »
some info about Ryan White guidelines for HIV primary care visits:

ryan white funded providers must follow the HRSA HAB guidelines for the "medical visit frequency" and "Gap in HIV Medical Visits" measures.

Medical Visit Frequency:
Percentage of patients, regardless of age, with a diagnosis of HIV who
had at least one medical visit in each 6-month period of the 24-month
measurement period with a minimum of 60 days between medical visits

Gap in HIV Medical Visits:
Percentage of patients, regardless of age, with a diagnosis of HIV who
did not have a medical visit in the last 6 months of the measurement

when looking at these measures, MVF should be a high number (a greater percentage of clients should be seen this often) for agencies providing quality healthcare, while the Gap measure should be low (fewer patients should be missing appointments).  The MVF is a complicated measure to track as it's the only HAB measure that is based on two years, not one year.

Currently the Ryan White Charlotte NC TGA quality committee has a quality improvement project to improve these measures. While we have nearly reached our goals for the measures, our goal for MVF is still set low.

Core 3     HIV Medical Visits Frequency     55.26%      goal: 60%
Core 4     Gap in HIV Medical Visits           20.35%      goal: 20%
(these percentages are based on 12 of our 14 providers, as two providers have not been in business for at least the 2 yrs needed for the MVF)

to improve MVF, we designed a presentation for providers and case managers (Medical_Visit_Frequency_storyboard.pdf) to explain this measure, along with a patient education poster.

leatherman (aka mIkIE)

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Sure enough, seasons change
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