Evaluating the HIV Continuum of Care and Metabolic Indicators at Grady IDP Open Access

Abstract

The Grady Infectious Disease Program (IDP) Ponce Clinic is one of the largest outpatient HIV clinics in the United States. IDP garners most of its funding, which provides free health care to people living with HIV (PLWH) in the Southeast, from the Ryan White Care Act. This assessment analyzed clinical quality and process indicators focusing on the HIV care continuum and metabolic disorders against Ryan White standard metrics for the HIV care continuum and standard diabetes mellitus (DM) metabolic metrics for patients at IDP between the years 2013 to 2017. Results showed suboptimal retention in care, but for those retained in care, there was exceptionally high rates of antiretroviral treatment (ART) prescription and virologic suppression. This showed room for improvement in retaining PLWH patients in care over long periods, as well as getting patients to adhere to ART.  Metabolic indicator results showed high compliance for those patients who had A1C tests completed, and mid-range compliance for blood pressure and cholesterol lab compliance. While there are decent levels of compliance for the metabolic indicators, most labs were not ordered as much as they should be, with A1C labs hovering between 600 and 1,100 labs ordered. Thus, the need for more routine screening and metabolic testing is highlighted by this assessment.

Table of Contents

Introduction .................................................................................................................................................. 1

About IDP .................................................................................................................................................. 1

HIV Continuum of Care ............................................................................................................................. 2

Diabetes Mellitus ...................................................................................................................................... 3

Quality and Process Improvement ............................................................................................................ 4 Methods ........................................................................................................................................................ 8

HIV Continuum of Care ............................................................................................................................. 8

Metabolic Indicators ............................................................................................................................... 12 Results......................................................................................................................................................... 15 Demographics ......................................................................................................................................... 15

HIV Continuum of Care ........................................................................................................................... 15

Metabolic Indicators ............................................................................................................................... 19 Discussion ................................................................................................................................................... 21

HIV Continuum of Care ........................................................................................................................... 21

Metabolic Indicators ............................................................................................................................... 22 Limitations ............................................................................................................................................... 22 Recommendations ..................................................................................................................................... 24

HIV Continuum of Care ........................................................................................................................... 24

Metabolic Indicators ............................................................................................................................... 25

Appendix A ................................................................................................................................................. 27 Bibliography................................................................................................................................................ 33

About this Master's Thesis

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School	Rollins School of Public Health
Department	Hubert Department of Global Health
Degree	M.P.H.
Submission	Master's Thesis
Language	English
Research Field	Health Sciences, Public Health
Keyword	Diabetes Mellitus HIV Metabolic
Committee Chair / Thesis Advisor	Dr. Vincent Marconi, Emory University
Partnering Agencies	Hospital or other health care provider

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