Mortality among clients in the New York city HIV Care Coordination Program (CCP): incidence and associated clinical factors

Abstract

Purpose: We examined psychosocial factors (housing, drug use, incarceration history or mental health) and care factors (comorbidities and acute care) associated with all-cause and HIV-related mortality while enrolled in the New York City Ryan White HIV Care Coordination Program (CCP), an intensive case management program for people with barriers to HIV care and treatment.

Methods: We used hazards regression (HR) to understand factors associated with mortality.

Results: 8,135 people (13,479.4 person years [PY]) enrolled in the CCP from March 2011 to December 2016. The all-cause mortality rate while enrolled was 28.8 per 1000 PY (N = 388), with 43% of deaths (N = 167) related to HIV (12.4 per 1000 PY). Controlling for demographics and clinical status, the variables associated with increased hazards of all-cause mortality included hospitalizations or emergency-department visits prior to enrollment (aHR_{Hospitalizations}: 2.54; 95% Confidence Interval 2.07-3.11 and aHR_ED: 1.54; 1.24-1.92) or a diabetes or Hepatitis C diagnosis at enrollment (aHR_Diabetes: 1.80; 1.36-2.37 and aHR_HCV: 1.78; 1.37-2.30). These factors also increased the hazards of HIV-related mortality.

Conclusions: CCP and similar case management programs should systematically screen enrolling clients for a history of acute care and comorbidities, as they may be important markers of need for more intensive engagement and follow-up to prevent death.

Keywords: Acute care; All-cause mortality; Case management; Comorbidities; Hiv.