101
|
Boeke CE, Nabitaka V, Rowan A, Guerra K, Nawaggi P, Mulema V, Bigira V, Magongo E, Mucheri P, Musoke A, Katureebe C. Results from a proactive follow-up intervention to improve linkage and retention among people living with HIV in Uganda: a pre-/post- study. BMC Health Serv Res 2018; 18:949. [PMID: 30522484 PMCID: PMC6282267 DOI: 10.1186/s12913-018-3735-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2018] [Accepted: 11/19/2018] [Indexed: 11/12/2022] Open
Abstract
Background Despite gains in HIV testing and treatment access in sub-Saharan Africa, patient attrition from care remains a problem. Evidence is needed of real-world implementation of low-cost, scalable, and sustainable solutions to reduce attrition. We hypothesized that more proactive patient follow-up and enhanced counseling by health facilities would improve patient linkage and retention. Methods At 20 health facilities in Central Uganda, we implemented a quality of care improvement intervention package that included training lay health workers in best practices for patient follow-up and counseling, including improved appointment recordkeeping, phone calls and home visits to lost patients, and enhanced adherence counseling strategies; and strengthening oversight of these processes. We compared patient linkage to and retention in HIV care in the 9 months before implementation of the intervention to the 9 months after implementation. Data were obtained from facility-based registers and files and analysed using multivariable logistic regression. Results Among 1900 patients testing HIV-positive during the study period, there was not a statistically significant increase in linkage to care after implementing the intervention (52.9% versus 54.9%, p = 0.63). However, among 1356 patients initiating antiretroviral therapy during the follow-up period, there were statistically significant increases in patient adherence to appointment schedules (44.5% versus 55.2%, p = 0.01) after the intervention. There was a small increase in Ministry of Health-defined retention in care (71.7% versus 75.7%, p = 0.12); when data from the period of intervention ramp-up was dropped, this increase became statistically significant (71.7% versus 77.6%, p = 0.01). The increase in retention was more dramatic for patients under age 19 years (N = 84; 64.0% versus 83.9%, p = 0.01). The cost per additional patient retained in care was $47. Conclusions Improving patient tracking and counseling practices was relatively low cost and enhanced patient retention in care, particularly for pediatric and adolescent patients. This approach should be considered for scale-up in Uganda and elsewhere. However, no impact was seen in improved patient linkage to care with this proactive follow-up intervention. Trial registration Pan African Clinical Trial Registry #PACTR201611001756166. Registered August 31, 2016.
Collapse
Affiliation(s)
- Caroline E Boeke
- Clinton Health Access Initiative (CHAI), 383 Dorchester Road, Suite 400, Boston, MA, 02127, USA.
| | | | | | - Katherine Guerra
- Clinton Health Access Initiative (CHAI), 383 Dorchester Road, Suite 400, Boston, MA, 02127, USA
| | | | | | | | | | | | | | | |
Collapse
|
102
|
Karch DL, Dong X, Shi J, Hall HI. Trends in Care and Treatment for Persons Aged ≥13 Years with HIV Infection 17 U.S. Jurisdictions, 2012-2015. Open AIDS J 2018; 12:90-105. [PMID: 30369994 PMCID: PMC6182879 DOI: 10.2174/1874613601812010090] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2018] [Revised: 08/22/2018] [Accepted: 09/09/2018] [Indexed: 11/22/2022] Open
Abstract
Background: Care and viral suppression national goals for HIV infection are not being met for many at-risk groups. Assessment of the trends in national outcomes for linkage to care, receipt of care, and viral suppression among these groups is necessary to reduce transmission. Methods: Data reported to the National HIV Surveillance System by December 2016 were used to identify cases of HIV infection among persons aged 13 years and older in one of 17 identified jurisdictions with complete laboratory reporting. We estimated national trends in HIV-related linkage to care, receipt of care and viral suppression using estimated annual percent change from 2012-2015 for various characteristics of interest, overall and stratified by sex and race/ethnicity. Results: Overall, trends in linkage to and receipt of care and viral suppression increased from 2012-2015. Generally, linkage to and receipt of care increased among young black and Hispanic/Latino males, those with infection attributed to male-to-male sexual contact, and those not in stage 3 [AIDS] at HIV diagnosis. All sub-groups showed improvement in viral suppression. Within years, there remains a substantial disparity in receipt of care and viral suppression among racial/ethnic groups. Conclusion: While trends are encouraging, scientifically proven prevention programs targeted to high-risk populations are the foundation for stopping transmission of HIV infection. Frequent testing to support early diagnosis and prompt linkage to medical care, particularly among young men who have male to male sexual contact, black and Hispanic/Latino populations, are key to reducing transmission at all stages of disease.
Collapse
Affiliation(s)
- Debra L Karch
- HIV Incidence and Case Surveillance Branch, Division of HIV Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD and TB Prevention, Centers for Disease Control and Prevention, 1600 Clifton Road NE, MS E-47, Atlanta, GA 30329, U.S
| | | | - Jing Shi
- ICF International, Inc, Atlanta, GA, U.S
| | - H I Hall
- HIV Incidence and Case Surveillance Branch, Division of HIV Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD and TB Prevention, Centers for Disease Control and Prevention, 1600 Clifton Road NE, MS E-47, Atlanta, GA 30329, U.S
| |
Collapse
|
103
|
Loeliger KB, Meyer JP, Desai MM, Ciarleglio MM, Gallagher C, Altice FL. Retention in HIV care during the 3 years following release from incarceration: A cohort study. PLoS Med 2018; 15:e1002667. [PMID: 30300351 PMCID: PMC6177126 DOI: 10.1371/journal.pmed.1002667] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2018] [Accepted: 09/05/2018] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Sustained retention in HIV care (RIC) and viral suppression (VS) are central to US national HIV prevention strategies, but have not been comprehensively assessed in criminal justice (CJ) populations with known health disparities. The purpose of this study is to identify predictors of RIC and VS following release from prison or jail. METHODS AND FINDINGS This is a retrospective cohort study of all adult people living with HIV (PLWH) incarcerated in Connecticut, US, during the period January 1, 2007, to December 31, 2011, and observed through December 31, 2014 (n = 1,094). Most cohort participants were unmarried (83.7%) men (77.0%) who were black or Hispanic (78.1%) and acquired HIV from injection drug use (72.6%). Prison-based pharmacy and custody databases were linked with community HIV surveillance monitoring and case management databases. Post-release RIC declined steadily over 3 years of follow-up (67.2% retained for year 1, 51.3% retained for years 1-2, and 42.5% retained for years 1-3). Compared with individuals who were not re-incarcerated, individuals who were re-incarcerated were more likely to meet RIC criteria (48% versus 34%; p < 0.001) but less likely to have VS (72% versus 81%; p = 0.048). Using multivariable logistic regression models (individual-level analysis for 1,001 individuals after excluding 93 deaths), both sustained RIC and VS at 3 years post-release were independently associated with older age (RIC: adjusted odds ratio [AOR] = 1.61, 95% CI = 1.22-2.12; VS: AOR = 1.37, 95% CI = 1.06-1.78), having health insurance (RIC: AOR = 2.15, 95% CI = 1.60-2.89; VS: AOR = 2.01, 95% CI = 1.53-2.64), and receiving an increased number of transitional case management visits. The same factors were significant when we assessed RIC and VS outcomes in each 6-month period using generalized estimating equations (for 1,094 individuals contributing 6,227 6-month periods prior to death or censoring). Additionally, receipt of antiretroviral therapy during incarceration (RIC: AOR = 1.33, 95% CI 1.07-1.65; VS: AOR = 1.91, 95% CI = 1.56-2.34), early linkage to care post-release (RIC: AOR = 2.64, 95% CI = 2.03-3.43; VS: AOR = 1.79; 95% CI = 1.45-2.21), and absolute time and proportion of follow-up time spent re-incarcerated were highly correlated with better treatment outcomes. Limited data were available on changes over time in injection drug use or other substance use disorders, psychiatric disorders, or housing status. CONCLUSIONS In a large cohort of CJ-involved PLWH with a 3-year post-release evaluation, RIC diminished significantly over time, but was associated with HIV care during incarceration, health insurance, case management services, and early linkage to care post-release. While re-incarceration and conditional release provide opportunities to engage in care, reducing recidivism and supporting community-based RIC efforts are key to improving longitudinal treatment outcomes among CJ-involved PLWH.
Collapse
Affiliation(s)
- Kelsey B. Loeliger
- AIDS Program, Section of Infectious Diseases, Yale School of Medicine, New Haven, Connecticut, United States of America
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, Connecticut, United States of America
| | - Jaimie P. Meyer
- AIDS Program, Section of Infectious Diseases, Yale School of Medicine, New Haven, Connecticut, United States of America
- * E-mail:
| | - Mayur M. Desai
- Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, Connecticut, United States of America
| | - Maria M. Ciarleglio
- Department of Biostatistics, Yale School of Public Health, New Haven, Connecticut, United States of America
| | - Colleen Gallagher
- Health and Addiction Services Quality Improvement Program, Connecticut Department of Correction, Wethersfield, Connecticut, United States of America
| | - Frederick L. Altice
- AIDS Program, Section of Infectious Diseases, Yale School of Medicine, New Haven, Connecticut, United States of America
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, Connecticut, United States of America
- Centre of Excellence in Research in AIDS, University of Malaya, Kuala Lumpur, Malaysia
| |
Collapse
|
104
|
Cluver L, Pantelic M, Toska E, Orkin M, Casale M, Bungane N, Sherr L. STACKing the odds for adolescent survival: health service factors associated with full retention in care and adherence amongst adolescents living with HIV in South Africa. J Int AIDS Soc 2018; 21:e25176. [PMID: 30240121 PMCID: PMC6149366 DOI: 10.1002/jia2.25176] [Citation(s) in RCA: 66] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2018] [Accepted: 07/13/2018] [Indexed: 01/19/2023] Open
Abstract
INTRODUCTION There are two million HIV-positive adolescents in southern Africa, and this group has low retention in care and high mortality. There is almost no evidence to identify which healthcare factors can improve adolescent self-reported retention. This study examines factors associated with retention amongst antiretroviral therapy (ART)-initiated adolescents in South Africa. METHODS We collected clinical records and detailed standardized interviews (n = 1059) with all 10- to 19 year-olds ever initiated on ART in all 53 government clinics of a health subdistrict, and community traced to include lost-to-follow-up (90.1% of eligible adolescents interviewed). Associations between full self-reported retention in care (no past-year missed appointments and 85% past-week adherence) and health service factors were tested simultaneously in sequential multivariate regression and marginal effects modelling, controlling for covariates of age, gender, urban/rural location, formal/informal housing, maternal and paternal orphanhood, vertical/horizontal HIV infection, overall health, length of time on ART and type of healthcare facility. RESULTS About 56% of adolescents had self-reported retention in care, validated against lower detectable viral load (AOR: 0.63, CI: 0.45 to 0.87, p = 0.005). Independent of covariates, five factors (STACK) were associated with improved retention: clinics Stocked with medication (OR: 3.0, CI: 1.6 to 5.5); staff with Time for adolescents (OR: 2.7, CI: 1.8 to 4.1); adolescents Accompanied to the clinic (OR: 2.3, CI: 1.5 to 3.6); enough Cash to get to clinic safely (OR: 1.4, CI: 1.1 to 1.9); and staff who are Kind (OR: 2.6, CI: 1.8 to 3.6). With none of these factors, 3.3% of adolescents reported retention. With all five factors, 69.5% reported retention. CONCLUSIONS This study identifies key intervention points for adolescent retention in HIV care. A basic package of clinic and community services has the potential to STACK the odds for health and survival for HIV-positive adolescents.
Collapse
Affiliation(s)
- Lucie Cluver
- Department of Social Policy and InterventionUniversity of OxfordOxfordUnited Kingdom
- Department of Psychiatry and Mental HealthUniversity of Cape TownCape TownSouth Africa
| | - Marija Pantelic
- Department of Social Policy and InterventionUniversity of OxfordOxfordUnited Kingdom
- SecretariatInternational HIV/AIDS AllianceBrightonUnited Kingdom
| | - Elona Toska
- AIDS and Society Research UnitUniversity of Cape TownCape TownSouth Africa
- Department of SociologyUniversity of Cape TownCape TownSouth Africa
| | - Mark Orkin
- MRC/Wits Developmental Pathways for Health Research UnitSchool of Clinical MedicineUniversity of the WitwatersrandJohannesburgSouth Africa
| | - Marisa Casale
- Department of Social Policy and InterventionUniversity of OxfordOxfordUnited Kingdom
- School of Public HealthUniversity of the Western CapeCape TownSouth Africa
| | | | - Lorraine Sherr
- Research Department of Global HealthUniversity College LondonLondonUnited Kingdom
| |
Collapse
|
105
|
Szadkowski L, Walmsley S, Burchell AN, Collins E, Rourke SB, Raboud J. High retention in HIV care at a tertiary care centre in Toronto, Canada. AIDS Care 2017; 30:246-254. [PMID: 28678619 DOI: 10.1080/09540121.2017.1349278] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Poor retention in HIV care is associated with poor clinical outcomes and mortality. Previous studies of predictors of poor retention have been conducted with a wide variety of populations, using different measures of retention, and occasionally have conflicting results. We studied demographic and psychosocial factors associated with inter-visit interval length in a setting of universal health care and modern cART. Patients attending ≥2 appointments with an HIV specialist at the Toronto General Hospital Immunodeficiency Clinic from 2004 to 2013 were studied. A sub-analysis included psychosocial measures from annual questionnaires for Ontario HIV Treatment Network Cohort Study (OCS) participants. Median inter-visit interval and constancy (percentage of 4-month intervals with ≥1 visit) were calculated by patient. Multivariable generalized estimating equation models identified factors associated with inter-visit interval length and intervals ≥12 months. 1591 patients were included. 615 patients completed an OCS questionnaire and were more likely to be older white MSM from Canada with a viral load (VL) <50 copies/ml. The median (IQR) of patients' median inter-visit intervals was 3.15 (2.78, 3.84) months and median (IQR) constancy was 90% (71%, 100%). Two percent of inter-visit intervals were ≥12 months and 25% of patients had ≥1 interval ≥12 months. Longer inter-visit intervals were associated with younger age, white race, earlier calendar year, longer duration of HIV, VL < 50 copies/mL and higher CD4 counts. Patients who were younger, white, had injection drug use as a risk factor, had a longer duration of HIV, and had VL ≥50 copies/mL were more likely to have an inter-visit interval ≥12 months. In the OCS sub-analysis including psychosocial variables, lower levels of depression were associated with longer inter-visit intervals. Retention at this tertiary care centre was high. Efforts to maximize attendance should focus on younger patients and those with substance abuse issues.
Collapse
Affiliation(s)
- Leah Szadkowski
- a Toronto General Hospital Research Institute , University Health Network , Toronto , Canada
| | - Sharon Walmsley
- a Toronto General Hospital Research Institute , University Health Network , Toronto , Canada.,b Division of Infectious Diseases , University Health Network , Toronto , Canada.,c Faculty of Medicine , University of Toronto , Toronto , Canada
| | - Ann N Burchell
- d Centre for Urban Health Solutions, Keenan Research Centre , Li Ka Shing Knowledge Institute, St. Michael's Hospital , Toronto , Canada.,e Department of Family and Community Medicine , St. Michael's Hospital , Toronto , Canada.,f Dalla Lana School of Public Health , University of Toronto , Toronto , Canada
| | - Evan Collins
- b Division of Infectious Diseases , University Health Network , Toronto , Canada.,g Department of Psychiatry , University of Toronto , Toronto , Canada
| | - Sean B Rourke
- d Centre for Urban Health Solutions, Keenan Research Centre , Li Ka Shing Knowledge Institute, St. Michael's Hospital , Toronto , Canada.,g Department of Psychiatry , University of Toronto , Toronto , Canada.,h Ontario HIV Treatment Network , Toronto , Canada
| | - Janet Raboud
- a Toronto General Hospital Research Institute , University Health Network , Toronto , Canada.,f Dalla Lana School of Public Health , University of Toronto , Toronto , Canada
| | -
- a Toronto General Hospital Research Institute , University Health Network , Toronto , Canada
| |
Collapse
|