title: Clinic Network Collaboration and Patient Tracing to Maximize Retention in HIV Care.
abstract: BACKGROUND
  Understanding retention and loss to follow up in HIV care, in particular the number of people with unknown outcomes, is critical to maximise the benefits of antiretroviral therapy. Individual-level data are not available for these outcomes in Australia, which has an HIV epidemic predominantly focused amongst men who have sex with men.
  
  
  RESULTS
  A network of the 6 main HIV clinical care sites was established in the state of Victoria, Australia. Individuals who had accessed care at these sites between February 2011 and June 2013 as assessed by HIV viral load testing but not accessed care between June 2013 and February 2014 were considered individuals with potentially unknown outcomes. For this group an intervention combining cross-referencing of clinical data between sites and phone tracing individuals with unknown outcomes was performed. 4966 people were in care in the network and before the intervention estimates of retention ranged from 85.9%-95.8% and the proportion with unknown outcomes ranged from 1.3-5.5%. After the intervention retention increased to 91.4-98.8% and unknown outcomes decreased to 0.1-2.4% (p<.01 for all sites for both outcomes). Most common reasons for disengagement from care were being too busy to attend or feeling well. For those with unknown outcomes prior to the intervention documented active psychiatric illness at last visit was associated with not re-entering care (p = 0.04).
  
  
  CONCLUSIONS
  The network demonstrated low numbers of people with unknown outcomes and high levels of retention in care. Increased levels of retention in care and reductions in unknown outcomes identified after the intervention largely reflected confirmation of clinic transfers while a smaller number were successfully re-engaged in care. Factors associated with disengagement from care were identified. Systems to monitor patient retention, care transfer and minimize disengagement will maximise individual and population-level outcomes for populations with HIV.
authors.affiliation: Department of Infectious Diseases, The Alfred Hospital and Monash University, Melbourne, Australia; Infectious Diseases Unit, Monash Health, Melbourne, Australia; Burnet Institute, Melbourne, Australia.
authors.forename: James H
authors.initials: JH
authors.lastname: McMahon
authors.affiliation: Northside Clinic, Melbourne, Australia.
authors.forename: Richard
authors.initials: R
authors.lastname: Moore
authors.affiliation: Prahran Market Clinic, Melbourne, Australia.
authors.forename: Beng
authors.initials: B
authors.lastname: Eu
authors.affiliation: Centre Clinic, Melbourne, Australia.
authors.forename: Ban-Kiem
authors.initials: BK
authors.lastname: Tee
authors.affiliation: Melbourne Sexual Health Centre, Alfred Health, Melbourne, Australia; Central Clinical School, Monash University, Melbourne, Australia.
authors.forename: Marcus
authors.initials: M
authors.lastname: Chen
authors.affiliation: Burnet Institute, Melbourne, Australia.
authors.forename: Carol
authors.initials: C
authors.lastname: El-Hayek
authors.affiliation: Royal Melbourne Hospital, Melbourne, Australia.
authors.forename: Alan
authors.initials: A
authors.lastname: Street
authors.affiliation: Department of Infectious Diseases, The Alfred Hospital and Monash University, Melbourne, Australia; Infectious Diseases Unit, Monash Health, Melbourne, Australia.
authors.forename: Ian
authors.initials: I
authors.lastname: Woolley
authors.affiliation: Melbourne Sexual Health Centre, Alfred Health, Melbourne, Australia.
authors.forename: Andrew
authors.initials: A
authors.lastname: Buggie
authors.affiliation: Centre Clinic, Melbourne, Australia.
authors.forename: Danielle
authors.initials: D
authors.lastname: Collins
authors.affiliation: Melbourne Sexual Health Centre, Alfred Health, Melbourne, Australia.
authors.forename: Nicholas
authors.initials: N
authors.lastname: Medland
authors.affiliation: Department of Infectious Diseases, The Alfred Hospital and Monash University, Melbourne, Australia.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Hoy
mesh_terms: D019058:Community Networks / Q000706:statistics & numerical data*; D003695:Delivery of Health Care / Q000379:methods* / Q000706:statistics & numerical data; D015658:HIV Infections / Q000175:diagnosis / Q000188:drug therapy* / Q000453:epidemiology*; D018451:Homosexuality, Male / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D017063:Outcome Assessment, Health Care; D010349:Patient Compliance; D014739:Victoria / Q000453:epidemiology; D019562:Viral Load