349. Implementation of a Multidisciplinary HIV-Pulmonary Clinic

Abstract

Abstract Background Among people with HIV (PWH), pulmonary comorbiditiees are a leading cause of morbidity and mortality. As PWH live a near-normal lifespan with ART, the focus has shifted from opportunistic infections to chronic disease. This includes chronic obstructive pulmonary disease (COPD) and lung cancer, for which PWH with and without concomitant tobacco use are at high risk. We sought to improve access to and quality of pulmonary care for PWH by instituting a pulmonary clinic co-located within a Ryan White-funded HIV clinic in the Southeastern United States. Methods A pulmonologist with expertise in lung disease in PWH began seeing patients one half-day twice monthly beginning in 2017. Longitudinal demographic, clinical, and appointment information was collected on each patient. Results Fifty patients were referred to the HIV-Pulmonary clinic. Of the 32 patients seen for an initial visit, the mean age was 55, 63% were male, and all were on ART. The majority were current (52%) or prior smokers (31%) with a mean pack-year history of 42. Over 40% of the patients had a COPD diagnosis and 25% had no prior pulmonary diagnosis. The majority of patients had not engaged in pulmonary care within the past year, as 63% had never seen a pulmonologist and another 28% did not follow-up with a prior provider. After the first visit, 69% either followed up or had a pending follow-up. Of the 17 current smokers, all were offered assistance with smoking cessation and 59% engaged. Of the 10 patients who were eligible for lung cancer screening (LCS) by current guidelines, all engaged in shared decision making and 40% pursued annual screening CT scans. Conclusion Chronic pulmonary diseases are increasing relevant comorbidity in PWH on ART. Our HIV-pulmonary clinic demonstrates the utility and feasibility of integration of sub-specialty consultative care in comprehensive care of PWH. By introducing a general pulmonary clinic within the existing infrastructure of the HIV clinic at our institution, we were able to engage PWH with and at risk for lung disease in longitudinal care to prevent, detect, and treat pulmonary disease. Future goals of this interdisciplinary design include increased compliance with current COPD treatment guidelines and LCS, improved rates of smoking cessation, and continued collaboration between the ID and pulmonary providers. Disclosures All authors: No reported disclosures.