Clinic Network Collaboration and Patient Tracing to Maximize Retention in HIV Care

Abstract

BackgroundUnderstanding retention and loss to follow up in HIV care, in particular the number of people with unknown outcomes, is critical to maximise the benefits of antiretroviral therapy. Individual-level data are not available for these outcomes in Australia, which has an HIV epidemic predominantly focused amongst men who have sex with men.Methods and FindingsA network of the 6 main HIV clinical care sites was established in the state of Victoria, Australia. Individuals who had accessed care at these sites between February 2011 and June 2013 as assessed by HIV viral load testing but not accessed care between June 2013 and February 2014 were considered individuals with potentially unknown outcomes. For this group an intervention combining cross-referencing of clinical data between sites and phone tracing individuals with unknown outcomes was performed. 4966 people were in care in the network and before the intervention estimates of retention ranged from 85.9%–95.8% and the proportion with unknown outcomes ranged from 1.3-5.5%. After the intervention retention increased to 91.4–98.8% and unknown outcomes decreased to 0.1–2.4% (p<.01 for all sites for both outcomes). Most common reasons for disengagement from care were being too busy to attend or feeling well. For those with unknown outcomes prior to the intervention documented active psychiatric illness at last visit was associated with not re-entering care (p = 0.04)ConclusionsThe network demonstrated low numbers of people with unknown outcomes and high levels of retention in care. Increased levels of retention in care and reductions in unknown outcomes identified after the intervention largely reflected confirmation of clinic transfers while a smaller number were successfully re-engaged in care. Factors associated with disengagement from care were identified. Systems to monitor patient retention, care transfer and minimize disengagement will maximise individual and population-level outcomes for populations with HIV.

Predictors of Adult Retention in HIV Care: A Systematic Review

“…Tobias et al [10] noted that subjects with poorer mental health scores were less likely to be retained in care. McMahon et al [18] further noted that active psychiatric illness at the last clinical visit was associated with not returning for care. Conversely, Blank et al [19] noted in their study that those who reported at least 14 “mentally unhealthy” days per month were more likely to remain retained in care.…”

“…Health beliefs appear to play an important role, and include feeling hopeless about treatment for HIV [19], or feeling well and being too busy [18]. In addition, perceiving ‘wellness’ as a barrier to seeking treatment, not trusting the medical system or not ‘bothering’ because there is no cure were identified by Tobias et al [10] as relevant beliefs which impacted retention.…”

“…Health beliefs in particular appear to have strong correlations (e.g. feeling too well or too busy; [18]). In addition, professional support in the form of case management appeared to positively assist vulnerable populations (e.g.…”

Two decades of surveillance data show late presentation among a diverse group of women diagnosed with HIV in Victoria, Australia

“…To improve outcomes for women diagnosed with HIV in Victoria, all are actively followed up by public health officers at the Victorian DHHS to ensure they are linked into care; however, data from this program were not available. A Victorian study aiming to understand retention and loss to follow‐up in HIV care estimated that between 91% and 99% of Victorians diagnosed with HIV were retained in care 29 . These results were not available by gender, however, and included HIV clinical care sites that were all based in metropolitan areas of Victoria, while 16% of WLHIV live in regional Victoria.…”

“…A Victorian study aiming to understand retention and loss to follow-up in HIV care estimated that between 91% and 99% of Victorians diagnosed with HIV were retained in care. 29 These results were not available by gender, however, and included HIV clinical care sites that were all based in metropolitan areas of Victoria, while 16% of WLHIV live in regional Victoria. Data from Victorian laboratory sentinel surveillance estimated that 87% of WLHIV receiving an HIV viral load test had an undetectable viral load in 2014.…”