An intervention of scheduling an appointment and contacting the patient successfully increased re-engagement among patients with HIV who had not had a primary care visit in the previous 6 months.
Christopher Joseph, LMSW, MPH
An intervention as simple as an investigator scheduling an appointment and asking the patient to confirm can be enough to encourage re-engagement in patients with HIV at risk of becoming un-retained.
Investigators led by Alexandra Abrams-Downey, MD, Department of Medicine, Division of Infectious Disease, Icahn School of Medicine at Mount Sinai, New York sought to demonstrate the effectiveness of an early intervention to encourage re-engagement in patients at the Jack Martin Fund Clinic, a New York State Designated AIDS Center within the Institute for Advance Medicine at Mount Sinai. The research team also included Christopher Joseph, LMSW, MPH, Institute for Advanced Medicine at Mount Sinai, New York and others.
Patients at high risk of becoming un-retained were those with no primary care follow-up in 6 months. Successful re-engagement was a primary care follow-up visit within 90 days of the intervention. Investigators conducted a chart review to collect demographic, co-morbidity, and HIV data for both the intervention group and a retrospectively determined control group.
“A unique aspect of this project is the focus on patients who are currently retained, but at risk of falling out of care, as opposed to patients already un-retained,” wrote the investigators.
Of participants in the intervention group (n = 84), most were male (55%), African American (54%), had a viral load of less than 20 (66%), and had a mental health diagnosis (71%). Of those in the identified control group, most were male (61%), African American (52%), had a viral load of less than 20 (69%), and had a mental health diagnosis (67%). There were no statistically significant differences between these groups regarding race, ethnicity, viral load, or comorbidities.
Within 3 months, 80% of those in the intervention group (n = 67) had successfully followed-up with a primary care visit, compared to 52% (n = 65) of those in the control group (P <.01).
The mean time to follow-up after the six-month window was 27.4 days for the intervention group compared to 78.3 days for the control group (P <.01). Additionally, the mean time to follow-up after the last primary care appointment was 207.4 days for the intervention group compared to 258.3 days for the control group (P <.01).
Investigators reported that viral suppression did not play a significant role within the intervention group, however, within the control group, unsuppressed patients (viral load >200) were less likely to follow-up.
Participants in the intervention group with a mental health diagnosis or who were older were more likely to follow-up.
Investigators noted the limits of the retrospective control group and the small sample size of the study. Additionally, a large number of patients (n = 43) were excluded from the intervention group because researchers were unable to contact them.
“This study demonstrates a low-intensity, high-yield, sustainable intervention that significantly increased re-engagement for patients with HIV that are at high risk of becoming un-retained,” wrote the authors.
The poster, “Pre-tained: Early Intervention for HIV Patients at High Risk of Becoming Un-retained,” was presented at ID Week 2018 in San Francisco, CA.
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