Authors: Piotr Klakowicz

Journal: Canadian Family Physician

Publication Year: 2016

Keywords: HIV/AIDS, Culturally Informed Care, Social Determinants of Health, Population Information, Mortality, Urban, STI/STD

Abstract:
Objective: To examine mortality rates among HIV-positive indigenous people and others after initiation of HIV care improvements based on the chronic care model to address high HIV-related mortality.

Design: Retrospective cohort preintervention-to-postintervention evaluation study.

Setting: Urban-core primary health care centre focused on indigenous people in Vancouver, BC.

Participants: Individuals infected with HIV.

Intervention: Adoption of the chronic care model to improve HIV care over time.

Main outcome measures: All-cause mortality and HIV-related mortality rates, overall and from preintervention (2007 to 2009) to postintervention (2010 to 2012), by indigenous ethnicity, were calculated from clinical data linked with the provincial HIV treatment clinical registry.

Results: Of the 546 eligible study patients, 323 (59%) self-identified as indigenous. Indigenous persons had higher all-cause mortality compared with other patients (14% vs 8%, P = .035; 6.25 vs 4.02 per 100 person-years [PYRs], P = .113), with an adjusted hazard ratio of 1.77 (95% CI 0.95 to 3.30). Indigenous persons also had higher HIV-related mortality (6% vs 2%, P=.027; 2.50 vs 0.89 per 100 PYRs, P=.063), with an adjusted hazard ratio of 2.88 (95% CI 0.93 to 8.92). Between 2007 to 2009 and 2010 to 2012, a significant decline was observed in all-cause mortality for indigenous patients (10.00 to 5.00 per 100 PYRs, P=.023) and a non-significant decline was observed in other patients (7.21 to 2.97 per 100 PYRs, P=.061). A significant decline in HIV-related mortality was also seen for indigenous patients (5.56 to 1.80 per 100 PYRs, P=.005).

Conclusion: Despite the overall higher risk of death among indigenous patients compared with others, the decline in mortality in HIV-positive indigenous patients after the initiation of efforts to improve HIV care at the clinic further support HIV primary care informed by indigenous issues and the adoption of the chronic care model.

Source: Link to Original Article.

Type of Resource: Peer-reviewed scientific article