Leveraging Inpatient records to characterize the HIV Care continuum in North Carolina (LINC-NC)

About This Grant

ABSTRACT Less than half of people with HIV (PWH) in the US are retained in outpatient HIV care, impeding access to life- saving antiretroviral therapy and increasing transmission risk. Hospitalizations are common among PWH, particularly PWH not engaged in care. An inpatient admission is an opportunity to link hospitalized PWH, either newly diagnosed or previously diagnosed but not in care, to outpatient HIV care following discharge. However, interventions to improve linkage to outpatient HIV care have been largely unsuccessful. Prior studies have been limited by fragmented data sources, often restricted to a single health system, cross-sectional data, or with insufficient variables to comprehensively examine complex risk factors influencing post-discharge care engagement. We propose to integrate complementary data sources that capture the full HIV care continuum among hospitalized PWH and collect qualitative data from key informants to investigate individual-, hospital-, community-, and policy-level determinants of post-discharge HIV care engagement. We will conduct this study in North Carolina (NC), where academic-public health partnerships have a proven track-record of using HIV surveillance data to inform public health interventions, improving care outcomes and interrupting transmissions. We will combine electronic health records (EHRs) from three of the largest health systems in NC with HIV surveillance data, including statewide viral loads, for the years 2018-2024. PWH will be matched across the data sources using highly accurate novel techniques that do not require sharing sensitive identifying data. Our study will include 34 hospitals that care for 80% of hospitalized PWH in NC. Care continuum outcomes and differences across hospitals will inform sampling for our qualitative work, engaging PWH, healthcare providers and administrators, and staff from community-based organizations involved in supporting engagement in HIV care for PWH. Our specific aims for this three-year grant are: 1) Characterize HIV care engagement pre- and post-discharge among hospitalized PWH; 2) Identify patient- and hospital-level predictors of post-discharge linkage to care; and 3) Explore key informants’ perceptions of factors that influence post-discharge linkage to care. In Aims 1-2, integrated EHRs capturing >600 in- and outpatient sites in all 100 NC counties and statewide HIV surveillance viral load data enables us to examine the full HIV care continuum among hospitalized PWH – diagnosis, linkage, retention, and viral suppression. Our collaboration capitalizes on clinical, epidemiological, and public health expertise at three academic institutions and the NC Division of Public Health, and leverages established partnerships with community-based organizations, local health jurisdictions, and community advisory boards. Combining HIV care continuum outcomes, predictors of care engagement following hospitalization, and a comprehensive examination of contextual determinants at individual, community, organization, and policy levels, we will identify modifiable targets from which we can develop tailored, multi-level interventions for subsequent testing.