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Title

Enhanced Personal Contact With HIV Patients Improves Retention in Primary Care: A Randomized Trial in 6 US HIV Clinics.

Authors

LI Gardner, TP Gordano, G. Marks, et al.

Network Affiliation

Other

Organization

 

Journal Name

Clin Infect  Dis.

Publication Date

5/1/2014

PubMed Search

http://www.ncbi.nlm.nih.gov/pubmed/?term=24837481

Link to full-text

 

PMID

24837481

Abstract

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.

Keywords

 

Topic

Behavior; Intervention; Recruitment & Retention

Attachments

Created at 8/14/2014 1:56 PM by Davis, Gregory P
Last modified at 8/14/2014 1:56 PM by Davis, Gregory P