title: Impact of the nurse-led case management program with retention in care on mortality among people with HIV-1 infection: a prospective cohort study.
abstract: BACKGROUND
  Long-term retention of patients in care is emerging as an important factor for the mortality among persons with human immunodeficiency virus (HIV) infection.
  
  
  OBJECTIVE
  The study was to determine the impact of the case management with retention in care on mortality among HIV infected patients.
  
  
  METHODS
  A longitudinal prospective cohort study was conducted at a tertiary referral HIV-designated hospital in Taiwan.
  
  
  METHODS
  Charts from 1040 patients who had made at least one visit for HIV care at the HIV Clinic in the study hospital in 2009 were abstracted.
  
  
  METHODS
  A computerized data collection form was used to retrospectively retrieve the electronic demographic and clinical data generated during each clinic visit. Follow-up ended at death or at the last clinic visit as of December 31, 2009.
  
  
  RESULTS
  Less than half (44.2%) of 961 HIV-infected patients were retained for follow-up from 2005 to 2009. Patients who received case management were 4.78 times more likely to remain consistently in care than those who did not receive case management, after controlling for other confounding variables. In the Cox proportional hazard analysis, higher hazards of death were independently associated with older age (hazard ratio [HR]: 1.04; 95% confidence interval [CI]: 1.026-1.055), entering care before 2005 (HR: 1.73; 95% CI: 1.035-2.885), low baseline CD4 cell count (HR: 0.997; 95% CI: 0.995-0.998), without antiretroviral therapy (HR: 0.55; 95% CI: 0.334-0.909), irregular attendance of HIV care or loss to follow-up (HR: 0.058; 95% CI: 0.023-0.148), acquisition of HIV infection through sexual contact (HR: 2.95; 95% CI: 1.517-5.746), and irregular attendance or lost to follow-up and did not enrolled in the case management program (HR: 3.76; 95% CI: 1.015-14.777).
  
  
  CONCLUSIONS
  Retention in care is independently predictive of survival, and case management is a mediator affecting retention on survival. Case managers need to identify high risk patients for irregular attendance and to retain them in HIV care in order to maximize their health outcomes.
authors.affiliation: Department of Nursing, College of Medicine, National Cheng Kung University, Tainan, Taiwan. nyko@mail.ncku.edu.tw
authors.forename: Nai-Ying
authors.initials: NY
authors.lastname: Ko
authors.forename: Yi-Yin
authors.initials: YY
authors.lastname: Lai
authors.forename: Hsiao-Ying
authors.initials: HY
authors.lastname: Liu
authors.forename: Hsin-Chun
authors.initials: HC
authors.lastname: Lee
authors.forename: Chia-Ming
authors.initials: CM
authors.lastname: Chang
authors.forename: Nan-Yao
authors.initials: NY
authors.lastname: Lee
authors.forename: Po-Lin
authors.initials: PL
authors.lastname: Chen
authors.forename: Ching-Chi
authors.initials: CC
authors.lastname: Lee
authors.forename: Wen-Chien
authors.initials: WC
authors.lastname: Ko
mesh_terms: D019090:Case Management; D015658:HIV Infections / Q000401:mortality / Q000451:nursing* / Q000628:therapy; D015497:HIV-1; D006801:Humans; D016016:Proportional Hazards Models; D011446:Prospective Studies; D013624:Taiwan / Q000453:epidemiology