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

Abstract

Background: 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.