TY - JOUR
T1 - A low-effort, clinic-wide intervention improves attendance for HIV primary care
AU - Gardner, Lytt I.
AU - Marks, Gary
AU - Craw, Jason A.
AU - Wilson, Tracey E.
AU - Drainoni, Mari Lynn
AU - Moore, Richard D.
AU - Mugavero, Michael J.
AU - Rodriguez, Allan E.
AU - Bradley-Springer, Lucy A.
AU - Holman, Susan
AU - Keruly, Jeanne C.
AU - Sullivan, Meg
AU - Skolnik, Paul R.
AU - Malitz, Faye
AU - Metsch, Lisa R.
AU - Raper, James L.
AU - Giordano, Thomas P.
N1 - Funding Information:
Financial support. This work was supported by the CDC and the HRSA (CDC contracts 200-2007-23685 to Baylor College of Medicine, 200-2007-23690 to Boston Medical Center, 200-2007-23689 to Johns Hopkins University School of Medicine, 200-2007-23687 to Research Foundation of the State University of New York, SUNY Downstate Medical Center, 200-2007-23684 to University of Alabama at Birmingham, and 200-2007-23692 to University of Miami Miller School of Medicine). Potential conflicts of interest. All authors: No reported conflicts.
PY - 2012/10/15
Y1 - 2012/10/15
N2 - Background. Retention in care for human immunodeficiency virus (HIV)-infected patients is a National HIV/AIDS Strategy priority. We hypothesized that retention could be improved with coordinated messages to encourage patients' clinic attendance. We report here the results of the first phase of the Centers for Disease Control and Prevention/Health Resources and Services Administration Retention in Care project. Methods. Six HIV-specialty clinics participated in a cross-sectionally sampled pretest-posttest evaluation of brochures, posters, and messages that conveyed the importance of regular clinic attendance. 10 018 patients in 2008-2009 (preintervention period) and 11 039 patients in 2009-2010 (intervention period) were followed up for clinic attendance. Outcome variables were the percentage of patients who kept 2 consecutive primary care visits and the mean proportion of all primary care visits kept. Stratification variables were: new, reengaging, and active patients, HIV RNA viral load, CD4 cell count, age, sex, race or ethnicity, risk group, number of scheduled visits, and clinic site. Data were analyzed by multivariable log-binomial and linear models using generalized estimation equation Methods. Results.Clinic attendance for primary care was significantly higher in the intervention versus preintervention year. Overall relative improvement was 7.0 for keeping 2 consecutive visits and 3.0 for the mean proportion of all visits kept (P <. 0001). Larger relative improvement for both outcomes was observed for new or reengaging patients, young patients and patients with elevated viral loads. Improved attendance among the new or reengaging patients was consistent across the 6 clinics, and less consistent across clinics for active patients.Conclusion.Targeted messages on staying in care, which were delivered at minimal effort and cost, improved clinic attendance, especially for new or reengaging patients, young patients, and those with elevated viral loads.
AB - Background. Retention in care for human immunodeficiency virus (HIV)-infected patients is a National HIV/AIDS Strategy priority. We hypothesized that retention could be improved with coordinated messages to encourage patients' clinic attendance. We report here the results of the first phase of the Centers for Disease Control and Prevention/Health Resources and Services Administration Retention in Care project. Methods. Six HIV-specialty clinics participated in a cross-sectionally sampled pretest-posttest evaluation of brochures, posters, and messages that conveyed the importance of regular clinic attendance. 10 018 patients in 2008-2009 (preintervention period) and 11 039 patients in 2009-2010 (intervention period) were followed up for clinic attendance. Outcome variables were the percentage of patients who kept 2 consecutive primary care visits and the mean proportion of all primary care visits kept. Stratification variables were: new, reengaging, and active patients, HIV RNA viral load, CD4 cell count, age, sex, race or ethnicity, risk group, number of scheduled visits, and clinic site. Data were analyzed by multivariable log-binomial and linear models using generalized estimation equation Methods. Results.Clinic attendance for primary care was significantly higher in the intervention versus preintervention year. Overall relative improvement was 7.0 for keeping 2 consecutive visits and 3.0 for the mean proportion of all visits kept (P <. 0001). Larger relative improvement for both outcomes was observed for new or reengaging patients, young patients and patients with elevated viral loads. Improved attendance among the new or reengaging patients was consistent across the 6 clinics, and less consistent across clinics for active patients.Conclusion.Targeted messages on staying in care, which were delivered at minimal effort and cost, improved clinic attendance, especially for new or reengaging patients, young patients, and those with elevated viral loads.
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U2 - 10.1093/cid/cis623
DO - 10.1093/cid/cis623
M3 - Article
C2 - 22828593
AN - SCOPUS:84866660103
SN - 1058-4838
VL - 55
SP - 1124
EP - 1134
JO - Clinical Infectious Diseases
JF - Clinical Infectious Diseases
IS - 8
ER -