Retention in HIV Care in Australia: The Perspectives of Clinicians and Clients, and the Impact of Medical and Psychosocial Comorbidity

Bulsara, Shiraze M.; Wainberg, Milton L.; Audet, Carolyn M.; Newton‐John, Toby

doi:10.1089/apc.2019.0094

Cited by 9 publications

(9 citation statements)

References 32 publications

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“…I ncomplete engagement in HIV care and treatment among persons living with HIV (PLWH) is a central barrier that must be overcome to achieve the goals of the Ending the HIV Epidemic initiative in the United States. 1 Although barriers to care that PLWH experience have been well described and synthesized in the literature, [2][3][4] few interventions have been demonstrated to re-engage individuals who have fallen out of care. 5 Most re-engagement interventions described to date have focused on changing patient care-seeking behavior or supporting patients in navigating the current HIV health care system.…”

Section: Introductionmentioning

confidence: 99%

“It's Me as a Person, Not Me the Disease”: Patient Perceptions of an HIV Care Model Designed to Engage Persons with Complex Needs

Beima‐Sofie

Begnel

Golden

et al. 2020

AIDS Patient Care and STDs

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Ending the HIV epidemic will require dedicated efforts to engage the highest need persons living with HIV (PLWH) in treatment. We assessed patient perceptions of a clinic in Seattle, Washington, that is designed for PLWH who do not engage in conventional HIV care. The Max Clinic provides walk-in access to care, incentives for blood draws and achieving viral suppression, and intensive case management. We conducted semistructured individual interviews with 25 patients purposively recruited to obtain diverse viewpoints. Interviews were audio-recorded and transcribed. Analysis used a constant comparative approach to identify major themes related to the components of the program. For many participants, engagement in the Max Clinic was the first time they had success with HIV treatment. Relationships with clinic staff and the ability to receive care on a walk-in basis had the strongest influences on engagement. Participants felt that Max Clinic staff attended to their social circumstances in ways that were distinct from prior care experiences. Walk-in visits removed perceived stigma associated with failure to keep appointments and provided immediate attention to acute concerns. Financial incentives initially motivated participants to attend clinic and take medications, but were less important for supporting ongoing engagement in care. Food incentives motivated patients to seek care and helped them focus on health issues. In summary, patients identified walk-in access to care, monetary and food incentives, and relationships with clinic staff, particularly case managers, as the key elements of an HIV clinic model for high-need PLWH.

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Section: Introductionmentioning

confidence: 99%

“It's Me as a Person, Not Me the Disease”: Patient Perceptions of an HIV Care Model Designed to Engage Persons with Complex Needs

Beima‐Sofie

Begnel

Golden

et al. 2020

AIDS Patient Care and STDs

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“…Interestingly, those with no clinician-identified comorbidity had an increased odds of being in the AUnotWHO group compared the psychosocial-alone group. It may be that these clients 'feel well' and therefore do not prioritize their appointments [19]. This could also account for the discrepancy in retention estimates, with clients potentially not agreeing with the schedule determined by their Doctor.…”

Section: Discussionmentioning

confidence: 99%

“…Future research in this area should seek to quantify this assertion. Increased points of connection with a service may, in fact, enhance retention [18,19]. Further, those who are socially isolated, one factor which comprised the psychosocial domain, could be accessing services more frequently to address their unmet social needs [20].…”

Section: Discussionmentioning

confidence: 99%

The Role of Comorbidity on Retention in HIV Care

et al. 2020

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Retention is a central component of the Cascade, facilitating monitoring of comorbidity. Country-specific definitions differ and may suit stable and functioning clients, while not appropriately classifying complex clinical presentations characterized by comorbidity. A retrospective file review of 363 people living with HIV attending a Sydney HIV clinic was conducted. Retention was compared with Australian (attendance once/12-months) and World Health Organization (attendance 'appropriate to need') recommendations to identify those attending according to the Australian definition, but not clinician recommendations (AUnotWHO). Multivariable logistic regression analyses determined the impact of age/sex and clinician-assessed comorbidity on retention. Most (97%) participants were considered retained according to the Australian definition, but only 56.7% according to clinician recommendations. Those with psychosocial comorbidity alone were less likely to be in the AUnotWHO group (OR 0.51, 95%CI 0.27-0.96, p = 0.04). The interaction of physical and psychosocial comorbidity was predictive of poor retention (Wald test: χ 2 = 6.39, OR 2.39 [95% CI 1.15-4.97], p = 0.01), suggesting a syndemic relationship.

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“…We acknowledge that a retrospective study design and limiting the inclusion of psychosocial factors to depression may have contributed to omitting significant outcomes in our analysis. [48][49][50] Other psychiatric and sociobehavioral factors should be considered for even more comprehensive quality-of-life metrics 51 and future research should include prospective data collection of these measures. In measuring depression, we assumed that the absence of a diagnosis of depression was due to proper assessment and ruling out of the condition, as screening for depression is a part of routine preventative care in KPMAS; however, we acknowledge that it is possible a lack of diagnosis could be due to lack of effective screening.…”

Section: Discussionmentioning

confidence: 99%

“…We intend to include in future HIV QM studies. [48][49][50][51] Finally, when examining effect of insurance coverage, we did not consider deductible level (pertinent to our ACA Marketplace patients), which could impact health care utilization and ability to meet QMs.…”

Section: Discussionmentioning

confidence: 99%

Beyond the HIV Care Continuum and Viral Suppression: Broadening the Scope of Quality Metrics for Total HIV Patient Care

Horberg

Certa

Rubenstein

et al. 2020

AIDS Patient Care and STDs

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Assessing quality care for people with HIV (PWH) should not be limited to reporting on HIV Care Continuum benchmarks, particularly viral suppression rates. At Kaiser Permanente Mid-Atlantic States (KPMAS), an integrated health system providing HIV care in the District of Columbia, Maryland, and Virginia, we created a comprehensive measure of HIV quality care, including both preventative measures and clinical outcomes. We included PWH ‡18 years old with ‡6 months KPMAS membership between 2015 and 2018. Process quality metrics (QMs) include: pneumococcal vaccination and influenza vaccination; primary care physician (PCP) and/or HIV/infectious disease (HIV/ID) visits with additional HIV/ID visit; antiretroviral treatment medication fills; and syphilis and gonorrhea/chlamydia screenings. Outcome QMs include HIV RNA <200/mL and other measurements within normal range [blood pressure, body mass index (BMI), hemoglobin, blood sugar, alanine transaminase, low-density lipoproteins, estimated glomerular filtration rate]; no hospitalization/emergency department visit; no new depression diagnosis; remaining or becoming a nonsmoker. Logistic models estimated odds of achieving QMs associated with sex, age, race/ethnicity, insurance type, and HIV risk. A total of 4996 observations were analyzed. 45.6% met all process QMs, while 19.6% met all outcome QMs. Least frequently met process QM was PCP or HIV/ID visit (74.5%); least met outcome QM was BMI (60.2%). Significantly lower odds of achieving all QMs among women {odds ratio (OR) = 0.63 [95% confidence interval (CI): 0.49-0.81]} and those with Medicaid and Medicare [vs. commercial; OR = 0.48 (95% CI: 0.30-0.76) and 0.47 (95% CI: 0.31-0.71)]. Broadening the scope of HIV patient care QMs beyond viral suppression helps identify opportunities for improvement. Successful process metrics do not necessarily coincide with greater outcome metrics.

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Retention in HIV Care in Australia: The Perspectives of Clinicians and Clients, and the Impact of Medical and Psychosocial Comorbidity

Cited by 9 publications

References 32 publications

“It's Me as a Person, Not Me the Disease”: Patient Perceptions of an HIV Care Model Designed to Engage Persons with Complex Needs

“It's Me as a Person, Not Me the Disease”: Patient Perceptions of an HIV Care Model Designed to Engage Persons with Complex Needs

The Role of Comorbidity on Retention in HIV Care

Beyond the HIV Care Continuum and Viral Suppression: Broadening the Scope of Quality Metrics for Total HIV Patient Care

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