Enhancing Linkage and Retention in HIV Care: a Review of Interventions for Highly Resourced and Resource-Poor Settings

Abstract

Given the widespread availability of effective anti-retroviral therapy, engagement of HIV-infected persons in care is a global priority. We reviewed 51 studies, published in the past decade, assessing strategies for improving linkage to and retention in HIV care. The review included studies from highly resourced settings (HRS) and resource-poor settings (RPS), specifically the USA and sub-Saharan Africa. In HRS, strength-based case management was best supported for improving linkage and retention in care; peer navigation and clinic-based health promotion were supported for improving retention. In RPS, point of care CD4 testing was best supported for improving linkage to care; decentralization, and task-shifting for improving retention. Novel interventions continue to emerge in HRS and RPS, yet many strategies have not been adequately evaluated. Further consideration should be given to analyses that identify which interventions, or combinations of interventions, are most effective, cost-effective, scalable, and aligned with patient preferences for HIV care.

Improving Engagement in the HIV Care Cascade: A Systematic Review of Interventions Involving People Living with HIV/AIDS as Peers

“…The efficacy of interventions designed to improve linkage and retention in HIV care and adherence to ART has also been recently reviewed (5–7). Interventions involving peers in various capacities were highlighted as one potential approach to improve the engagement of PLHA in care (5).…”

“…Peers play many roles in HIV prevention and treatment interventions, including educating patients, offering social support, and providing referrals for social services. Peers have also been employed as navigators, working directly with patients to identify and overcome specific barriers to accessing care and maintaining engagement in HIV care (7). In these roles peers offer patients a combination of logistical assistance with navigating the health care delivery system (e.g., scheduling appointments, arranging transportation, etc.…”

Re-engagement in HIV Care: A Clinical and Public Health Priority

“…There are a number of studies that suggest ways to prevent loss to care. Two review papers examined multiple studies on interventions to improve retention in care [16,17]. They described a wide variety of interventions that include personal contact before appointments and when patients miss visits, home visits, education on the importance of staying in care, directly observed therapy, case management, transportation assistance, patient navigators, counseling, mental health services, substance abuse treatment, housing assistance, motivational interviewing and peer mentoring.…”

“…In any event, Okeke et al reported on nine studies that used a pre-post design and reported improvement in retention in care by PLWH. In seven of the nine studies, the improvement was less than 15% [16]. These studies provide little guidance for what clinicians may do to retain their patients in care.…”

Getting to 90: linkage to HIV care among men who have sex with men and people who inject drugs in India

“…However, fears regarding rejection and stigma from family, friends, and the community once their status is known are important to consider and mitigate (Kumarasamy et al, 2005). Utilization of peer navigators could be useful for MSM and PWID for whom a peer may be a trusted confidant and source of support and information (Blacksher et al, 2012; Govindasamy et al, 2014; Okeke, Ostermann, & Thielman, 2014). These three modifiable factors – disclosure, assistance with medical care, and information and counseling on care and treatment – together were predictive of whether or not individuals were linked to care with high accuracy independently of demographic differences and other barriers to linkage including substance use, depression, and stigma.…”