Background The Ryan White Modernisation Care Act 2006 integrated medical case management with supportive social services to ensure that Persons Living with HIV/AIDS (PLWHA) from lower socioeconomic, marginalised groups, and those with mental health/substance use issues are sustained in medical care. This study sought to establish the relationship between the CD4 and viral load of PLWHA and the receipt of ancillary services.
Methods A random sample of N=222 subjects were drawn from the Bluegrass Care Clinic (BCC) database. The cohort was 67% white, 21.6% black, and 8.6% Hispanic with the majority of the subjects between 100 and 149% of the poverty level. Self-reported HIV risk factors for the sample were 59.9% MSM, 28.4% heterosexual, and 8.1% IDU. This sample adequately represents the population of the BCC as ethnicity, socioeconomic status and risk factors were similar for the clinic population as a whole. One way ANOVA tests were used to determine if the receipt of ancillary services by PLWHA in the BCC affects their viral loads and CD4 counts by using a multivariable analysis.
Results There was a statistically significant difference in mean CD4 counts when comparing between ethnicities. The ANOVA test showed a statistically significant relationship (p=0.002) between Hispanic ethnicity and mean CD4 count, as subjects in the study that were of Hispanic origin had lower mean CD4 counts (305) than non-Hispanic whites (550) and non-Hispanic African Americans (500). There was also a statistically significant difference (p=0.021) between the mean viral load of PLWHA having one to three mental health visits and PLWHA with no mental health visits at all.
Conclusion At the BCC, patients with adherence issues appear to be referred for mental health services, confirming the essential role of social workers on a multi-disciplinary HIV team. The BCC also has a Hispanic population with disproportionately lower CD4 counts. Implications for program improvement are to continue to target Hispanic patients with lower CD4 counts to retain them in medical care and improve adherence to ART medications. This study was limited by the fact that ancillary social services were lumped in with medical case management in the data set rather than delineated into individual service categories. Future research should use data sets that more accurately capture the various ancillary services provided to the sample subjects.
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