by Carolyn Chu, MD, MSc, AAHIVS, AAHIVM Chief Medical Officer
May 10, 2022
Wood BR, Bauer K, Lechtenberg R, et. al. Direct and indirect effects of a Project ECHO longitudinal clinical tele-mentoring program on viral suppression for persons with HIV: a population-based analysis. J Acquir Immune Defic Syndr. 2022 Apr 29. doi: 10.1097/QAI.0000000000003007. PMID: 35499527.
Health workforce capacity-building is a key component of the updated National HIV/AIDS Strategy—provider-level interventions such as Project ECHO can help disseminate and standardize best clinical practices through virtual communities of practice and learning. Project ECHO in particular aims to reach providers with limited specialist access, and outcomes have historically focused on qualitative measures, i.e., provider confidence, self-efficacy, and professional satisfaction. This study explored patient viral load (VL) outcomes for medical providers participating in the University of Washington/Mountain West AETC’s Project ECHO program using 2011-2018 population-based data from Washington and Oregon (states which have comprehensive VL reporting systems). Patient demographic characteristics by Project ECHO participation status were generally similar. The percentage of patients with VL suppression (defined as VL ≤ 200 copies/mL) increased over time in both Project ECHO and non-Project ECHO cohorts, however, after adjusting for time, geographic location, and several patient and provider factors, participation was associated with an increased proportion of patients with VL suppression compared to no participation. Among patients of Project ECHO participants, overall VL suppression rate was significantly higher (by 13.7 percentage points) although authors note differences varied by provider PWH panel size. Additionally, greater improvement in the proportion of patients achieving VL suppression was observed among providers attending a larger number of ECHO sessions, though this also varied by panel volume.
It is highly encouraging that results of this study point to favorable patient-level HIV treatment outcomes associated with a provider-facing capacity building intervention such as Project ECHO. Secondary analyses also suggest indirect benefits: namely, VL suppression among patients of lower-volume providers who didn’t participate in Project ECHO themselves but worked in the same clinic system as at least one Project ECHO participant was higher than patients of providers with no engagement/connection to Project ECHO. Given the evolving nature of HIV care and advances in antiretroviral therapy, alongside the limited exposure most medical, nursing, and pharmacy students get to HIV medicine, dynamic and effective practice-based capacity building interventions such as virtual learning collaboratives are much needed. The impact of scaling up and expanding the reach of such efforts may be especially meaningful for PWH living in rural areas and/or individuals receiving care from lower PWH panel-volume providers.
The author has no conflicts of interest to disclose.
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