Randomized Trial of a Health Coaching Intervention to Enhance Retention in Care: California Collaborative Treatment Group 594

Abstract

Poor linkage, engagement and retention remain significant barriers in achieving HIV treatment goals in the US. HIV-infected persons entering or re-entering care across three Southern California academic HIV clinics, were randomized (1:1) to an Active, Linkage, Engagement, Retention and Treatment (ALERT) specialist for outreach and health coaching, or standard of care (SOC). The primary outcome of time to loss to follow up (LTFU) was compared using Cox proportional hazards regression modeling. No differences in the median time to LTFU (81.7 for ALERT versus 93.6 weeks for SOC; HR 1.27; p = 0.40), or time to ART initiation was observed (N = 116). Although, ALERT participants demonstrated worsening depressive symptomatology from baseline to week 48 compared to SOC (p = 0.02). The ALERT intervention did not improve engagement and retention in HIV care over SOC. Further studies are needed to determine how best to apply resources to improve retention and engagement.

Strategies to improve HIV care outcomes for people with HIV who are out of care

“…Most studies were non-RCTs (81%) [13–16,18,21,32–56]. For the eight RCTs, comparison arms were care as usual [19,57,58], wait-list control [59], featured content unrelated to re-engaging in care [60,61], or they did not receive an enhanced component that the intervention arm received [16,62].…”

“…To assess the effect of study design on the findings, the Q B statistics showed that the aggregated effect sizes in RCTs were significantly smaller than the ones observed in non-RCTs for retention (Q B = 10.21, P = 0.001), but not for viral suppression (Q B = 3.42, P = 0.06). We did not conduct a stratified meta-analysis for re-engagement because only one study was an RCT [58].…”

“…The mean age was 42 years. For study quality, two (7%) interventions were considered strong [19,61], 16 (38%) were rated as moderate quality [16,21,32,41,44,45,54,58,60,62,63], and 24 (57%) were determined as weak [13][14][15]18,[35][36][37][38][39][40]42,43,46,47,[49][50][51][52][53][55][56][57]59,64]. The most common intervention strategies were patient navigation, followed by appointment help/alert, psychosocial support, data to care, and transportation/appointment accompaniment (Table 2).…”

“…The most common timeframe for the OOC definition was being OOC between 6 and 12 months [14,16,18,[32][33][34]36,40,42,43,47,48,[51][52][53][54][55][58][59][60][61][62][63], followed by 3-4 months [13,19,39,57] and over 12 months [35,41,44,45,50]. Five studies included PWH who were OOC and at risk for becoming OOC [15,21,49,53,56].…”

“…Six interventions used nurse navigators [13,21,51,56,57,59] Appointment help/alerts Twenty-three interventions included appointment assistance as an intervention component. Appointment assistance encompassed multiple activities: scheduling [40,44,47,48,57], sending reminders via phone calls, texts orapps [18,21,43,46,50,54,58,62,63], coordination [15], follow up if appointments missed [43,45], and using automated alerts notifying providers that patients were OOC and needed appointments [19,33,37,38,41,52]. Positive effects were found for re-engagement (OR ¼ 1.72; 95% CI: Overall effects for all three outcomes did not change substantially when we removed one study at atime.…”