TY - JOUR
T1 - Enhanced personal contact with HIV patients improves retention in primary care
T2 - A randomized trial in 6 US HIV clinics
AU - Gardner, Lytt I.
AU - Giordano, Thomas P.
AU - Marks, Gary
AU - Wilson, Tracey E.
AU - Craw, Jason A.
AU - Drainoni, Mari Lynn
AU - Keruly, Jeanne C.
AU - Rodriguez, Allan E.
AU - Malitz, Faye
AU - Moore, Richard D.
AU - Bradley-Springer, Lucy A.
AU - Holman, Susan
AU - Rose, Charles E.
AU - Girde, Sonali
AU - Sullivan, Meg
AU - Metsch, Lisa R.
AU - Saag, Michael
AU - Mugavero, Michael J.
PY - 2014/9/1
Y1 - 2014/9/1
N2 - Background. The aim of the study was to determine whether enhanced personal contact with human immunodeficiency virus (HIV)-infected patients across time improves retention in care compared with existing standard of care (SOC) practices, and whether brief skills training improves retention beyond enhanced contact. Methods. The study, conducted at 6 HIV clinics in the United States, included 1838 patients with a recent history of inconsistent clinic attendance, and new patients. Each clinic randomized participants to 1 of 3 arms and continued to provide SOC practices to all enrollees: enhanced contact with interventionist (EC) (brief face-to-face meeting upon returning for care visit, interim visit call, appointment reminder calls, missed visit call); EC + skills (organization, problem solving, and communication skills); or SOC only. The intervention was delivered by project staff for 12 months following randomization. The outcomes during that 12-month period were (1) percentage of participants attending at least 1 primary care visit in 3 consecutive 4-month intervals (visit constancy), and (2) proportion of kept/scheduled primary care visits (visit adherence). Results. Log-binomial risk ratios comparing intervention arms against the SOC arm demonstrated better outcomes in both the EC and EC + skills arms (visit constancy: risk ratio [RR], 1.22 [95% confidence interval {CI}, 1.09- 1.36] and 1.22 [95% CI, 1.09-1.36], respectively; visit adherence: RR, 1.08 [95% CI, 1.05-1.11] and 1.06 [95% CI, 1.02 -1.09], respectively; all Ps < .01). Intervention effects were observed in numerous patient subgroups, although they were lower in patients reporting unmet needs or illicit drug use. Conclusions. Enhanced contact with patients improved retention in HIV primary care compared with existing SOC practices. A brief patient skill-building component did not improve retention further. Additional intervention elements may be needed for patients reporting illicit drug use or who have unmet needs. Clinical Trials Registration. CDCHRSA9272007.
AB - Background. The aim of the study was to determine whether enhanced personal contact with human immunodeficiency virus (HIV)-infected patients across time improves retention in care compared with existing standard of care (SOC) practices, and whether brief skills training improves retention beyond enhanced contact. Methods. The study, conducted at 6 HIV clinics in the United States, included 1838 patients with a recent history of inconsistent clinic attendance, and new patients. Each clinic randomized participants to 1 of 3 arms and continued to provide SOC practices to all enrollees: enhanced contact with interventionist (EC) (brief face-to-face meeting upon returning for care visit, interim visit call, appointment reminder calls, missed visit call); EC + skills (organization, problem solving, and communication skills); or SOC only. The intervention was delivered by project staff for 12 months following randomization. The outcomes during that 12-month period were (1) percentage of participants attending at least 1 primary care visit in 3 consecutive 4-month intervals (visit constancy), and (2) proportion of kept/scheduled primary care visits (visit adherence). Results. Log-binomial risk ratios comparing intervention arms against the SOC arm demonstrated better outcomes in both the EC and EC + skills arms (visit constancy: risk ratio [RR], 1.22 [95% confidence interval {CI}, 1.09- 1.36] and 1.22 [95% CI, 1.09-1.36], respectively; visit adherence: RR, 1.08 [95% CI, 1.05-1.11] and 1.06 [95% CI, 1.02 -1.09], respectively; all Ps < .01). Intervention effects were observed in numerous patient subgroups, although they were lower in patients reporting unmet needs or illicit drug use. Conclusions. Enhanced contact with patients improved retention in HIV primary care compared with existing SOC practices. A brief patient skill-building component did not improve retention further. Additional intervention elements may be needed for patients reporting illicit drug use or who have unmet needs. Clinical Trials Registration. CDCHRSA9272007.
KW - Behavioral intervention trial
KW - HIV infection
KW - HIV specialty clinics
KW - Randomized controlled trial
KW - Retention in care
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UR - http://www.scopus.com/inward/citedby.url?scp=84906260246&partnerID=8YFLogxK
U2 - 10.1093/cid/ciu357
DO - 10.1093/cid/ciu357
M3 - Article
C2 - 24837481
AN - SCOPUS:84906260246
SN - 1058-4838
VL - 59
SP - 725
EP - 734
JO - Clinical Infectious Diseases
JF - Clinical Infectious Diseases
IS - 5
ER -