Adherence to comprehensive diabetes measures in people with HIV managed in a primary care clinic

Abstract

Background

People with HIV (PWH) have higher rates of diabetes and cardiovascular disease, yet often receive inadequate screening for related comorbidities. This study assessed adherence to comprehensive diabetes care metrics in PWH and diabetes and identified predictors of poor screening compliance.

Methods

A retrospective chart review was conducted for patients ≥18 years of age with HIV and diabetes, receiving primary care at a Federally Qualified Health Center Look-Alike site in New Mexico during 2019 or 2020. Diabetes care was evaluated using Healthcare Effectiveness Data and Information Set metrics: hemoglobin A1c, foot and eye exams, urine albumin-to-creatinine ratio, blood pressure, and statin use in patients aged 40 to 75 years. Patients overdue for one or more metrics were identified for quality interventions by clinical pharmacists.

Results

A total of 121 patients met study inclusion criteria and were included for data analysis. The average age of the cohort was 57.5 ± 10.2 years. The majority of patients were white (76.9%) and identified as male (86.8%). During the evaluation period, the majority of patients, 119 (98.3%), missed one or more clinic appointments, and 114 (94.2%) were overdue for ≥1 screening metrics; 14 patients (11.5%) were overdue for all screening metrics. Eye exams were the most commonly overdue. In multivariate analysis, polypharmacy predicted hemoglobin A1c screening completion. Other factors, including demographics, rural residence, statin use, number of appointments attended, estimated atherosclerotic cardiovascular disease risk, glycemic control (last recorded hemoglobin A1c value), CD4 count, and viral load, did not predict A1c screening.

Conclusion

Comprehensive diabetes care measures were alarmingly low in PWH, highlighting a need for targeted interventions to improve chronic disease management in this high-risk population.