Certain settings of care (i.e. high volume of HIV positive patients) and models of care (i.e. case management) may improve patient mortality and other outcomes. More detailed descriptions of care models, consistent definition of terms, and studies on innovative models suitable for developing countries are needed. There is not yet enough evidence to guide policy and clinical care in this area.
Effect of comprehensive intervention program on survival of patients with human immunodeficiency virus infection.
In October 1989, an early intervention program (EIP) for human immunodeficiency virus (HIV) infection was initiated in New Jersey to provide medical care and social services to the enrollees.
                To assess the overall effect of the EIP on the survival of HIV-infected patients.
                Patient information collected through June 30, 1993, was analyzed from the Jersey City Medical Center EIP clinic. Survival from enrollment to death was calculated for patients who received follow-up at the clinic (active) and for those who only had the enrollment visit (inactive). The data were matched with the New Jersey death certificate registry.
                Of 938 patients enrolled from October 1989 to December 1991, 767 had T-cell subsets determined within 3 months of enrollment: 641 patients were active and 126 were inactive. At entry, inactive patients had a lower median CD4+ T-cell count and were more likely to be symptomatic than active patients. Among the 640 active and 125 inactive patients analyzed for survival (survivors > or = 2 months), there were 144 (22.5%) and 48 (38.4%) deaths, respectively. Kaplan-Meier analysis indicated longer survival for active patients than for inactive patients (P < .001, Wilcoxon's test for homogeneity of strata); eg, survival probability at 2 years was 86% for active patients and 64% for inactive patients. Active patients also had longer survival than inactive patients when stratified by CD4+ T-cell levels or by clinical status. Only active and inactive patients with both CD4+ T-cell levels lower than 0.20 x 10(9)/L (< 200/microL) and symptoms of HIV or acquired immunodeficiency syndrome had similar survival rates. Survival was not influenced by sex, race, or HIV transmission category.
                Participation in the EIP was associated with longer survival of HIV-infected patients.