Impact of the nurse-led case management program with retention in care on mortality among people with HIV-1 infection: A prospective cohort study

Nai-Ying Ko, Yi Yin Lai, Hsiao Ying Liu, Hsin Chun Lee, Chia-Ming Chang, Nan-Yao Lee, Po-Lin Chen, Ching Chi Lee, Wen-Chien Ko

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Abstract

Background: Long-term retention of patients in care is emerging as an important factor for the mortality among persons with human immunodeficiency virus (HIV) infection. Objectives: The study was to determine the impact of the case management with retention in care on mortality among HIV infected patients. Design and settings: A longitudinal prospective cohort study was conducted at a tertiary referral HIV-designated hospital in Taiwan. Participants: Charts from 1040 patients who had made at least one visit for HIV care at the HIV Clinic in the study hospital in 2009 were abstracted. Methods: A computerized data collection form was used to retrospectively retrieve the electronic demographic and clinical data generated during each clinic visit. Follow-up ended at death or at the last clinic visit as of December 31, 2009. Results: Less than half (44.2%) of 961 HIV-infected patients were retained for follow-up from 2005 to 2009. Patients who received case management were 4.78 times more likely to remain consistently in care than those who did not receive case management, after controlling for other confounding variables. In the Cox proportional hazard analysis, higher hazards of death were independently associated with older age (hazard ratio [HR]: 1.04; 95% confidence interval [CI]: 1.026-1.055), entering care before 2005 (HR: 1.73; 95% CI: 1.035-2.885), low baseline CD4 cell count (HR: 0.997; 95% CI: 0.995-0.998), without antiretroviral therapy (HR: 0.55; 95% CI: 0.334-0.909), irregular attendance of HIV care or loss to follow-up (HR: 0.058; 95% CI: 0.023-0.148), acquisition of HIV infection through sexual contact (HR: 2.95; 95% CI: 1.517-5.746), and irregular attendance or lost to follow-up and did not enrolled in the case management program (HR: 3.76; 95% CI: 1.015-14.777). Conclusion: Retention in care is independently predictive of survival, and case management is a mediator affecting retention on survival. Case managers need to identify high risk patients for irregular attendance and to retain them in HIV care in order to maximize their health outcomes.

Original languageEnglish
Pages (from-to)656-663
Number of pages8
JournalInternational Journal of Nursing Studies
Volume49
Issue number6
DOIs
Publication statusPublished - 2012 Jun 1

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Case Management
Virus Diseases
HIV-1
Cohort Studies
Nurses
HIV
Prospective Studies
Mortality
Confidence Intervals
Ambulatory Care
Confounding Factors (Epidemiology)
Survival
Lost to Follow-Up
CD4 Lymphocyte Count
Taiwan
Patient Care
Referral and Consultation
Demography
Health

All Science Journal Classification (ASJC) codes

  • Nursing(all)

Cite this

@article{d62192106ba94bcf8464ec975217d921,
title = "Impact of the nurse-led case management program with retention in care on mortality among people with HIV-1 infection: A prospective cohort study",
abstract = "Background: Long-term retention of patients in care is emerging as an important factor for the mortality among persons with human immunodeficiency virus (HIV) infection. Objectives: The study was to determine the impact of the case management with retention in care on mortality among HIV infected patients. Design and settings: A longitudinal prospective cohort study was conducted at a tertiary referral HIV-designated hospital in Taiwan. Participants: Charts from 1040 patients who had made at least one visit for HIV care at the HIV Clinic in the study hospital in 2009 were abstracted. Methods: A computerized data collection form was used to retrospectively retrieve the electronic demographic and clinical data generated during each clinic visit. Follow-up ended at death or at the last clinic visit as of December 31, 2009. Results: Less than half (44.2{\%}) of 961 HIV-infected patients were retained for follow-up from 2005 to 2009. Patients who received case management were 4.78 times more likely to remain consistently in care than those who did not receive case management, after controlling for other confounding variables. In the Cox proportional hazard analysis, higher hazards of death were independently associated with older age (hazard ratio [HR]: 1.04; 95{\%} confidence interval [CI]: 1.026-1.055), entering care before 2005 (HR: 1.73; 95{\%} CI: 1.035-2.885), low baseline CD4 cell count (HR: 0.997; 95{\%} CI: 0.995-0.998), without antiretroviral therapy (HR: 0.55; 95{\%} CI: 0.334-0.909), irregular attendance of HIV care or loss to follow-up (HR: 0.058; 95{\%} CI: 0.023-0.148), acquisition of HIV infection through sexual contact (HR: 2.95; 95{\%} CI: 1.517-5.746), and irregular attendance or lost to follow-up and did not enrolled in the case management program (HR: 3.76; 95{\%} CI: 1.015-14.777). Conclusion: Retention in care is independently predictive of survival, and case management is a mediator affecting retention on survival. Case managers need to identify high risk patients for irregular attendance and to retain them in HIV care in order to maximize their health outcomes.",
author = "Nai-Ying Ko and Lai, {Yi Yin} and Liu, {Hsiao Ying} and Lee, {Hsin Chun} and Chia-Ming Chang and Nan-Yao Lee and Po-Lin Chen and Lee, {Ching Chi} and Wen-Chien Ko",
year = "2012",
month = "6",
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language = "English",
volume = "49",
pages = "656--663",
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TY - JOUR

T1 - Impact of the nurse-led case management program with retention in care on mortality among people with HIV-1 infection

T2 - A prospective cohort study

AU - Ko, Nai-Ying

AU - Lai, Yi Yin

AU - Liu, Hsiao Ying

AU - Lee, Hsin Chun

AU - Chang, Chia-Ming

AU - Lee, Nan-Yao

AU - Chen, Po-Lin

AU - Lee, Ching Chi

AU - Ko, Wen-Chien

PY - 2012/6/1

Y1 - 2012/6/1

N2 - Background: Long-term retention of patients in care is emerging as an important factor for the mortality among persons with human immunodeficiency virus (HIV) infection. Objectives: The study was to determine the impact of the case management with retention in care on mortality among HIV infected patients. Design and settings: A longitudinal prospective cohort study was conducted at a tertiary referral HIV-designated hospital in Taiwan. Participants: Charts from 1040 patients who had made at least one visit for HIV care at the HIV Clinic in the study hospital in 2009 were abstracted. Methods: A computerized data collection form was used to retrospectively retrieve the electronic demographic and clinical data generated during each clinic visit. Follow-up ended at death or at the last clinic visit as of December 31, 2009. Results: Less than half (44.2%) of 961 HIV-infected patients were retained for follow-up from 2005 to 2009. Patients who received case management were 4.78 times more likely to remain consistently in care than those who did not receive case management, after controlling for other confounding variables. In the Cox proportional hazard analysis, higher hazards of death were independently associated with older age (hazard ratio [HR]: 1.04; 95% confidence interval [CI]: 1.026-1.055), entering care before 2005 (HR: 1.73; 95% CI: 1.035-2.885), low baseline CD4 cell count (HR: 0.997; 95% CI: 0.995-0.998), without antiretroviral therapy (HR: 0.55; 95% CI: 0.334-0.909), irregular attendance of HIV care or loss to follow-up (HR: 0.058; 95% CI: 0.023-0.148), acquisition of HIV infection through sexual contact (HR: 2.95; 95% CI: 1.517-5.746), and irregular attendance or lost to follow-up and did not enrolled in the case management program (HR: 3.76; 95% CI: 1.015-14.777). Conclusion: Retention in care is independently predictive of survival, and case management is a mediator affecting retention on survival. Case managers need to identify high risk patients for irregular attendance and to retain them in HIV care in order to maximize their health outcomes.

AB - Background: Long-term retention of patients in care is emerging as an important factor for the mortality among persons with human immunodeficiency virus (HIV) infection. Objectives: The study was to determine the impact of the case management with retention in care on mortality among HIV infected patients. Design and settings: A longitudinal prospective cohort study was conducted at a tertiary referral HIV-designated hospital in Taiwan. Participants: Charts from 1040 patients who had made at least one visit for HIV care at the HIV Clinic in the study hospital in 2009 were abstracted. Methods: A computerized data collection form was used to retrospectively retrieve the electronic demographic and clinical data generated during each clinic visit. Follow-up ended at death or at the last clinic visit as of December 31, 2009. Results: Less than half (44.2%) of 961 HIV-infected patients were retained for follow-up from 2005 to 2009. Patients who received case management were 4.78 times more likely to remain consistently in care than those who did not receive case management, after controlling for other confounding variables. In the Cox proportional hazard analysis, higher hazards of death were independently associated with older age (hazard ratio [HR]: 1.04; 95% confidence interval [CI]: 1.026-1.055), entering care before 2005 (HR: 1.73; 95% CI: 1.035-2.885), low baseline CD4 cell count (HR: 0.997; 95% CI: 0.995-0.998), without antiretroviral therapy (HR: 0.55; 95% CI: 0.334-0.909), irregular attendance of HIV care or loss to follow-up (HR: 0.058; 95% CI: 0.023-0.148), acquisition of HIV infection through sexual contact (HR: 2.95; 95% CI: 1.517-5.746), and irregular attendance or lost to follow-up and did not enrolled in the case management program (HR: 3.76; 95% CI: 1.015-14.777). Conclusion: Retention in care is independently predictive of survival, and case management is a mediator affecting retention on survival. Case managers need to identify high risk patients for irregular attendance and to retain them in HIV care in order to maximize their health outcomes.

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