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


BACKGROUND
CDCHRSA9272007.
Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia.
Lytt I
LI
Gardner
Department of Medicine, Baylor College of Medicine, and the Center for Innovations in Quality, Effectiveness and Safety, Michael. E. DeBakey Veterans Affairs Medical Center, Houston, Texas.
Thomas P
TP
Giordano
Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia.
Gary
G
Marks
Department of Community Health Sciences, State University of New York (SUNY) Downstate Medical Center School of Public Health, Brooklyn.
Tracey E
TE
Wilson
Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia.
Jason A
JA
Craw
Department of Health Policy & Management, Boston University School of Public Health Center for Healthcare Organization and Implementation Research, Edith Nourse Rogers Memorial VA Hospital Department of Medicine, Boston University School of Medicine, Boston, Massachusetts.
Mari-Lynn
ML
Drainoni
Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland.
Jeanne C
JC
Keruly
Division of Infectious Diseases, Miller School of Medicine, University of Miami, Florida.
Allan E
AE
Rodriguez
HIV/AIDS Bureau, Health Resources and Services Administration, Rockville, Maryland.
Faye
F
Malitz
Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland.
Richard D
RD
Moore
School of Medicine, University of Colorado Denver, Aurora, CO.
Lucy A
LA
Bradley-Springer
Colleges of Medicine and Nursing, SUNY Downstate Medical Center, Brooklyn, New York.
Susan
S
Holman
Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia.
Charles E
CE
Rose
Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia ICF International, Inc, Atlanta, Georgia.
Sonali
S
Girde
Department of Medicine, Boston University School of Medicine, Boston, Massachusetts.
Meg
M
Sullivan
Department of Epidemiology and Public Health, University of Miami, Florida.
Lisa R
LR
Metsch
1917 HIV/AIDS Clinic and Department of Medicine, University of Alabama at Birmingham.
Michael
M
Saag
1917 HIV/AIDS Clinic and Department of Medicine, University of Alabama at Birmingham.
Michael J
MJ
Mugavero
D000293:Adolescent; D000328:Adult; D000554:Ambulatory Care Facilities; D001071:Appointments and Schedules; D005260:Female; D015658:HIV Infections / Q000188:drug therapy; D006301:Health Services Needs and Demand; D006801:Humans; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D010342:Patient Acceptance of Health Care; D010353:Patient Education as Topic; D011320:Primary Health Care; D011369:Professional-Patient Relations; D059039:Standard of Care; D014481:United States; D055815:Young Adult
HIV infection; HIV specialty clinics; behavioral intervention trial; randomized controlled trial; retention in care