Effectiveness of a chronic care program for adults living with HIV in Buenos Aires (“PAMI en positivo”)

Abstract

Background

The chronic care model (CCM) attempts to improve the quality of care. We aimed to evaluate the effectiveness of a CCM-based program for predominantly older adults living with HIV in Buenos Aires, Argentina (“PAMI en positivo”), describe the population included, and the monthly cost of antiretroviral treatment (ART).

Methods

Quasi-experimental study, pre-post intervention. Effectiveness was evaluated as a decrease in the proportion of patients on ART with viral load (VL) <200 c/ml.

Results

Forty patients were included, 18 (45.0%) women, age 64.6 (51.3-70.6) years, time since diagnosis 12 (6.7-21.3) years, 30 (75.0%) retired and 25 (62.5%) with comorbidities. The proportion on ART increased from 85% to 100% (p-value 0.03125) and the proportion on ART with CV<200 c/ml increased from 73.5% to 92.5% (p-value 0.001953). The average monthly cost of ART per patient decreased from USD 768 to USD 603 (p-value 0.04282). Only 50% had shared their diagnosis with their emotional network, 52.5% received the minimum retirement amount and 35% required psychosocial support. Their networks and adherence to ART were strengthened. The demand for food assistance was responded to, as well as support in managing access to ART and other benefits.

Conclusions

The program was effective and reduced the cost of ART. Having framed the care of predominantly older adults living with HIV in an interdisciplinary program allowed to make visible integral aspects that exceed HIV, revealing the health, social and emotional vulnerability of this population.