The Impact of a Walk-In HIV Care Model for People who are Incompletely Engaged in Care: the Moderate Needs (MOD) Clinic

Thesis (Master's)--University of Washington, 2023Background: The MOD Clinic in Seattle, Washington provides walk-in primary care for people with HIV who are incompletely engaged in standard care.Methods: We evaluated HIV outcomes among patients enrolled in the MOD Clinic (within group analysis) and, separately, among MOD patients vs. patients who were MOD-eligible but did not enroll (comparison group analysis) during 1/1/2018-9/30/2021. The primary outcome was viral suppression (VS; viral load <200 copies/mL); secondary outcomes care engagement (≥ 2 visits ≥60 days apart) and sustained VS (≥2 consecutive suppressed viral loads ≥60 days apart). In the within group analysis, we examined outcomes at time of MOD enrollment vs. 12 months post-enrollment. In the comparison group analysis, we examined outcomes at the time of MOD eligibility vs. 12 months post-eligibility. Both analyses used modified Poisson regression. Results: Most patients in MOD (N=213) were unstably housed (52%) and had psychiatric comorbidities (86%) or hazardous substance use (81%). Among patients enrolled ≥12 months (N=164), VS did not increase significantly from baseline to post-enrollment (63% to 71%, p=0.11), but care engagement and sustained VS both improved (37% to 86%, p<0.001; and 20% to 53%, p<0.001, respectively) from pre-enrollment to 12 months post-enrollment. In the comparison group analysis, VS worsened in non-enrolled patients (N=517) from baseline to 12-months post-eligibility (82% to 75%, p<0.001). MOD patients who met criteria for the comparison group analysis (N=68) were more likely than non-enrolled patients to be engaged in care at 12 months post-eligibility (RR 1.29; 95% CI 1.03-1.63). Conclusions: MOD Clinic enrollment was associated with improved engagement in care. This model adds to the spectrum of differentiated HIV care services

Using time‐weighted average change from baseline of SARS‐CoV‐2 viral load to assess impact of hydroxychloroquine as postexposure prophylaxis and early treatment for COVID‐19

Two randomized controlled trials demonstrated no clinical benefit of hydroxychloroquine (HCQ) for either postexposure prophylaxis or early treatment of SARS-CoV-2 infection. Using data from these studies, we calculated the time-weighted average change from baseline SARS-CoV-2 viral load and demonstrated that HCQ did not affect viral clearance