The Impact of the Ryan White HIV/AIDS Medical Case Management Program on HIV Clinical Outcomes: A Longitudinal Study

Medical case management (MCM) is a core medical service in The Ryan White HIV/AIDS Program and aims to provide treatment and care for people living with HIV/AIDS by engaging, identifying and eliminating barriers to HIV care. Little research has examined the impact of this intervention; therefore, the purpose of this study was to examine the how MCM affects HIV clinical outcomes. The study took place at a midwestern, outpatient infectious diseases clinic. This study utilized a longitudinal, retrospective study design to analyze to the impact of MCM engagement on HIV clinical outcomes (viral loads, CD4 counts) from 2009 to 2015 as a time-varying predictor. A total of 2773 patients were included in this study, of which 975 patients (35.2%) engaged in MCM. Among those in MCM, approximately 90% of the population were between 25 and 64 years of age, more than three-quarters were African American men, mean time of HIV care engagement in at this clinic care was 3.2 (+/- 4.1), while mean years living with HIV was 10.5 (+/- 7.1). Throughout the study period, those engaged in MCM had a significantly faster improvement in their HIV clinical outcomes compared to the non-MCM group (p < 0.001). The study highlights the significant impact MCM services have on improving CD4 T cell counts and HIV viral loads. The successful care coordination that MCM offers clearly improves health outcomes while creating a network of patient care.