Outreach Program Contacts: Do They Increase the Likelihood of Engagement and Retention in HIV Primary Care for Hard-to-Reach Patients?

Abstract

Engagement in HIV primary care and the receipt of antiretroviral therapy when clinically indicated offers patients the opportunity to experience HIV disease as a chronic illness. Yet many people, particularly those with comorbid mental health or substance abuse conditions and those who face multiple barriers to care, cycle in and out of care and thus can not reap the life-prolonging benefits of antiretroviral therapy. Although there is evidence about the impact of different interventions on adherence to HIV medications, there is little information about the impact of interventions on engagement or retention in HIV primary care among the hard-to-reach. In this multisite, national study, we contribute new information by exploring the relationship between outreach program contacts and retention in care over a 12-month period among participants in a demonstration project to promote engagement and retention in HIV primary care. We found that when participants received nine or more contacts during the first 3 months of their programs, they were about half as likely to have a substantial gap (defined as 4 months or more) in primary care during the first 12 months of follow-up. This finding remained after controlling for baseline CD4 count. These findings can be used to improve the effectiveness of programs to increase engagement and retention in HIV primary care among the hard-to-reach.

Retaining HIV‐Infected Patients in Care: Where Are We? Where Do We Go from Here?

“…In addition, increased frequency of contact with clinicians, peers, and paraprofessionals in or outside the medical office results in fewer gaps in care during the first 12 months of follow-up [39]. These preliminary studies suggest that navigators and supportive services help the most vulnerable populations to stay in care [39]. More data are needed, however, to better understand how clinic characteristics influence patient retention.…”

“…Other studies suggest that supportive services help specific populations, such as substance users, those with psychiatric illnesses [44], and atrisk youth, to stay in care [40]. In addition, increased frequency of contact with clinicians, peers, and paraprofessionals in or outside the medical office results in fewer gaps in care during the first 12 months of follow-up [39]. These preliminary studies suggest that navigators and supportive services help the most vulnerable populations to stay in care [39].…”

From Access to Engagement: Measuring Retention in Outpatient HIV Clinical Care

“…The length of the time interval or whether the time interval exceeds a pre-determine threshold, typically ranging between 4 and 12 months, can be used as the measure. [13][14][15] From the example in Figure 1, we see that patients B and D had a gap of over 6 months between completed visits, whereas patients A and C did not have a gap in care.…”

“…Delayed linkage and poor retention in outpatient HIV care have been associated with delayed receipt of antiretroviral medications, higher rates of viral load failure, and increased morbidity and mortality. [5][6][7][8][9][10][11][12][13][14][15][16][17] Beyond the effects on individual health, engagement in HIV care has important consequences for the public health as it plays a pivotal role in HIV transmission and secondary HIV infections. Studies have demonstrated reduced risk transmission behavior among HIVinfected patients engaged in clinical care, 18,19 and viral load suppression, which is achieved more commonly among those with better retention, 6,9 also reduces risk of transmission.…”

“…Recent studies, the majority of which have been retrospective and observational in design, have used a number of differing approaches to measure retention in care. [5][6][7][8][9][10][11][12][13][14][15][16][17] To date, there has not been a published summary of these measures to serve as a guide and provide a common nomenclature for HIV retention measures. A recent review of retention in care noted, ''a clear framework for how patient retention is defined and how it should be measured remains outstanding.''…”