TY - JOUR
T1 - Early Use of the Palliative Approach to Improve Patient Outcomes in HIV Disease
T2 - Insights and Findings From the Care and Support Access (CASA) Study 2013-2019
AU - Alexander, Carla S.
AU - Raveis, Victoria H.
AU - Karus, Daniel
AU - Carrero-Tagle, Monique
AU - Lee, Mei Ching
AU - Pappas, Gregory
AU - Lockman, Kashelle
AU - Brotemarkle, Rebecca
AU - Memiah, Peter
AU - Mulasi, Ila
AU - Hossain, Basile Mian
AU - Welsh, Christopher
AU - Henley, Yvonne
AU - Piet, Leslie
AU - N’Diaye, Sabrina
AU - Murray, Renard
AU - Haltiwanger, David
AU - Smith, Carlton Ray
AU - Flynn, Colin
AU - Redfield, Robert
AU - Silva, Caroline L.
AU - Amoroso, Anthony
AU - Selwyn, Peter
N1 - Publisher Copyright:
© The Author(s) 2020.
PY - 2021/4
Y1 - 2021/4
N2 - Young men of color who have sex with men (yMSM) living with human immunodeficiency virus (HIV) in syndemic environments have been difficult-to-retain in care resulting in their being at-risk for poor health outcomes despite availability of effective once-daily antiretroviral treatment (ART). Multiple methods have been implemented to improve outcomes for this cohort; none with sustainable results. Outpatient HIV staff themselves may be a contributing factor. We introduced multidisciplinary staff to the concept of using a palliative approach early (ePA) in outpatient HIV care management to enable them to consider the patient-level complexity of these young men. Young MSM (18-35 years of age) enrolled in and cared for at the intervention site of the Care and Support Access Study (CASA), completed serial surveys over 18 months. Patients’ Global and Summary quality of life (QoL) increased during the study at the intervention site (IS) where staff learned about ePA, compared with patients attending the control site (CS) (p=.021 and p=.018, respectively). Using serial surveys of staff members, we found that in the era of HIV disease control, outpatient staff are stressed more by environmental factors than by patients’ disease status seen historically in the HIV epidemic. A Community Advisory Panel of HIV stakeholders contributed to all phases of this study and altered language used in educational activities with staff members to describe the patient cohort.
AB - Young men of color who have sex with men (yMSM) living with human immunodeficiency virus (HIV) in syndemic environments have been difficult-to-retain in care resulting in their being at-risk for poor health outcomes despite availability of effective once-daily antiretroviral treatment (ART). Multiple methods have been implemented to improve outcomes for this cohort; none with sustainable results. Outpatient HIV staff themselves may be a contributing factor. We introduced multidisciplinary staff to the concept of using a palliative approach early (ePA) in outpatient HIV care management to enable them to consider the patient-level complexity of these young men. Young MSM (18-35 years of age) enrolled in and cared for at the intervention site of the Care and Support Access Study (CASA), completed serial surveys over 18 months. Patients’ Global and Summary quality of life (QoL) increased during the study at the intervention site (IS) where staff learned about ePA, compared with patients attending the control site (CS) (p=.021 and p=.018, respectively). Using serial surveys of staff members, we found that in the era of HIV disease control, outpatient staff are stressed more by environmental factors than by patients’ disease status seen historically in the HIV epidemic. A Community Advisory Panel of HIV stakeholders contributed to all phases of this study and altered language used in educational activities with staff members to describe the patient cohort.
KW - chronic disease management
KW - comparative effectiveness
KW - human immunodeficiency virus
KW - palliative care
KW - quality of life
KW - young men who have sex with men
UR - http://www.scopus.com/inward/record.url?scp=85089973322&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85089973322&partnerID=8YFLogxK
U2 - 10.1177/1049909120951129
DO - 10.1177/1049909120951129
M3 - Article
C2 - 32851870
AN - SCOPUS:85089973322
SN - 1049-9091
VL - 38
SP - 332
EP - 339
JO - American Journal of Hospice and Palliative Medicine
JF - American Journal of Hospice and Palliative Medicine
IS - 4
ER -