Enhanced personal contact with HIV patients improves retention in primary care: A randomized trial in 6 US HIV clinics

Lytt I. Gardner, Thomas P. Giordano, Gary Marks, Tracey E. Wilson, Jason A. Craw, Mari Lynn Drainoni, Jeanne C. Keruly, Allan E. Rodriguez, Faye Malitz, Richard D. Moore, Lucy A. Bradley-Springer, Susan Holman, Charles E. Rose, Sonali Girde, Meg Sullivan, Lisa R. Metsch, Michael Saag, Michael J. Mugavero

Research output: Contribution to journalArticle

93 Scopus citations

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.

Original languageEnglish (US)
Pages (from-to)725-734
Number of pages10
JournalClinical Infectious Diseases
Volume59
Issue number5
DOIs
StatePublished - Sep 1 2014

Keywords

  • Behavioral intervention trial
  • HIV infection
  • HIV specialty clinics
  • Randomized controlled trial
  • Retention in care

ASJC Scopus subject areas

  • Infectious Diseases
  • Microbiology (medical)

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    Gardner, L. I., Giordano, T. P., Marks, G., Wilson, T. E., Craw, J. A., Drainoni, M. L., Keruly, J. C., Rodriguez, A. E., Malitz, F., Moore, R. D., Bradley-Springer, L. A., Holman, S., Rose, C. E., Girde, S., Sullivan, M., Metsch, L. R., Saag, M., & Mugavero, M. J. (2014). Enhanced personal contact with HIV patients improves retention in primary care: A randomized trial in 6 US HIV clinics. Clinical Infectious Diseases, 59(5), 725-734. https://doi.org/10.1093/cid/ciu357