A low-effort, clinic-wide intervention improves attendance for HIV primary care
Lytt I Gardner, Gary Marks, Jason A Craw, Tracey E Wilson, Mari-Lynn Drainoni, Richard D Moore, Michael J Mugavero, Allan E Rodriguez, Lucy A Bradley-Springer, Susan Holman, Jeanne C Keruly, Meg Sullivan, Paul R Skolnik, Faye Malitz, Lisa R Metsch, James L Raper, Thomas P Giordano, Retention in Care Study Group, Mari-Lynn Drainoni, Cintia Ferreira, Lisa Koppelman, Roosevelt Lewis, Maya McDoom, Michal Naisteter, Karina Osella, Glory Ruiz, Meg Sullivan, Sophia Gibbs-Cohen, Elana Desrivieres, Mayange Frederick, Kevin Gravesande, Susan Holman, Harry Johnson, Tonya Taylor, Tracey Wilson, Laura Cheever, Faye Malitz, Robert Mills, Jason Craw, Lytt Gardner, Sonali Girde, Gary Marks, Scott Batey, Stephanie Gaskin, Michael Mugavero, Jill Murphree, Jim Raper, Michael Saag, Suneetha Thogaripally, James Willig, Anne Zinski, Monisha Arya, David Bartholomew, Tawanna Biggs, Hina Budhwani, Jessica Davila, Thomas P Giordano, Nancy Miertschin, Shapelle Payne, William Slaughter, Mollie Jenckes, Jeanne Keruly, Angie McCray, Mary McGann, Richard Moore, Melissa Otterbein, Liming Zhou, Carolyn Garzon, Jesline Jean-Simon, Kathy Mercogliano, Lisa Metsch, Allan Rodriguez, Gilbert Saint-Jean, Marvin Shika, Lucy Bradley-Springer, Marla Corwin, Lytt I Gardner, Gary Marks, Jason A Craw, Tracey E Wilson, Mari-Lynn Drainoni, Richard D Moore, Michael J Mugavero, Allan E Rodriguez, Lucy A Bradley-Springer, Susan Holman, Jeanne C Keruly, Meg Sullivan, Paul R Skolnik, Faye Malitz, Lisa R Metsch, James L Raper, Thomas P Giordano, Retention in Care Study Group, Mari-Lynn Drainoni, Cintia Ferreira, Lisa Koppelman, Roosevelt Lewis, Maya McDoom, Michal Naisteter, Karina Osella, Glory Ruiz, Meg Sullivan, Sophia Gibbs-Cohen, Elana Desrivieres, Mayange Frederick, Kevin Gravesande, Susan Holman, Harry Johnson, Tonya Taylor, Tracey Wilson, Laura Cheever, Faye Malitz, Robert Mills, Jason Craw, Lytt Gardner, Sonali Girde, Gary Marks, Scott Batey, Stephanie Gaskin, Michael Mugavero, Jill Murphree, Jim Raper, Michael Saag, Suneetha Thogaripally, James Willig, Anne Zinski, Monisha Arya, David Bartholomew, Tawanna Biggs, Hina Budhwani, Jessica Davila, Thomas P Giordano, Nancy Miertschin, Shapelle Payne, William Slaughter, Mollie Jenckes, Jeanne Keruly, Angie McCray, Mary McGann, Richard Moore, Melissa Otterbein, Liming Zhou, Carolyn Garzon, Jesline Jean-Simon, Kathy Mercogliano, Lisa Metsch, Allan Rodriguez, Gilbert Saint-Jean, Marvin Shika, Lucy Bradley-Springer, Marla Corwin
Abstract
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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Source: PubMed