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Enhanced personal contact improved retention in HIV care
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Retention in HIV care was improved among individuals who received enhanced personal contact beyond existing standard of care, according to recent data published in Clinical Infectious Diseases.
“The clinical message is that it is possible to significantly improve retention in care using a very modest behavioral intervention based on personal contact,” Lytt I. Gardner, PhD, epidemiologist at CDC’s Division of HIV/AIDS, told Infectious Disease News. “Improved retention in care is the first step to improve clinical outcomes. Patients who stay connected to their HIV clinic have been shown in other research to have better clinical indicators and better survival.”
Lytt I. Gardner
Gardner and colleagues conducted the study at six HIV clinics and included 1,838 patients. At each clinic, the patients were randomly assigned to one of three intervention arms: enhanced contact, enhanced contact plus skills and standard of care. Enhanced contact involved a dedicated interventionist maintaining personal contact with the patient. Enhanced contact plus skills added a 1-hour session for support, motivation and behavioral skills training for the patients. The standard of care included appointment reminder calls. The interventions were delivered for 12 months.
Both of the enhanced contact arms had higher visit constancy and visit adherence than the standard of care arm. Visit constancy was 22% higher for both of the enhanced contact arms compared with the standard of care (RR=1.22; 95% CI, 1.09-1.36). In terms of visit adherence, it was 8% higher in the enhanced contact arm and 6% higher in the enhanced contact plus skills arm vs. standard of care.
“We investigated many subgroups in the study, and although most responded well, we found that two subgroups — patients with a recent history of illicit drug use and patients with one or more unmet needs, such as housing, food, transportation, insurance and mental health — responded less well to the intervention,” Gardner said. “These groups may need additional, more intensive approaches in which the resources are directed to specifically address those problems.”
Gardner said these study results suggest that if clinics can identify patients at risk for falling out of care and establish ways to have clinic staff stay in touch with them, then clinics may be able to keep their patients engaged in care.
“The continuum of HIV care is the contemporary focus for the domestic HIV agenda and retention in care represents the biggest gap and opportunity in the continuum,” Gardner said. — by Emily Shafer.
Disclosure: Gardner reports no relevant financial disclosure.
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