title: Outcomes of a Clinic-Based Surveillance-Informed Intervention to Relink Patients to HIV Care.
abstract: BACKGROUND
  Improving patient retention in HIV care is crucial to improving the HIV care continuum. We instituted and evaluated a relinkage program that uses clinical data to identify potentially out-of-care patients, matches those data to public health surveillance, and employs a linkage specialist (LS) to coordinate care relinkage.
  
  
  METHODS
  The intervention began November 1, 2012, in the largest HIV clinic in Washington State. We evaluated program outcomes and compared patient outcomes in the year after initiation of the intervention to a historical control cohort of patients. Cox proportional hazard ratios were used to compare time to relinkage to care between cohorts, and regression models using generalized estimated equations were preformed to examine secondary outcomes of relinkage to care, engagement in care, and viral suppression.
  
  
  RESULTS
  A total of 753 patients were identified as "out of care" on November 1, 2012. Matching with surveillance data and initial LS investigations found that 596 (79%) of these patients had moved, transferred care, or were incarcerated. Of the 157 remaining patients, 40 (25%) relinked to care before LS contact, and the LS successfully contacted 38 (24%). A total of 116 (15%) patients in the intervention cohort relinked to care and 24 (20%) were contacted by the LS. Compared with the historical cohort, the time to relinkage was shorter among patients in the intervention cohort [adjusted hazard ratio = 1.7 (1.2-2.3)] and a greater proportion relinked (15% vs. 10%).
  
  
  CONCLUSIONS
  This clinic-based surveillance-informed relinkage intervention showed statistically significant but modest effectiveness in returning out-of-care patients to HIV care compared with historical controls.
authors.affiliation: *Center for AIDS and STD, University of Washington, Seattle, WA; †Department of Medicine, University of Washington, Seattle, WA; ‡Public Health-Seattle & King County HIV/STD Program, Seattle, WA; and §Department of Epidemiology, University of Washington, Seattle, WA.
authors.forename: Joanna M
authors.initials: JM
authors.lastname: Bove
authors.forename: Matthew R
authors.initials: MR
authors.lastname: Golden
authors.forename: Shireesha
authors.initials: S
authors.lastname: Dhanireddy
authors.forename: Robert D
authors.initials: RD
authors.lastname: Harrington
authors.forename: Julia C
authors.initials: JC
authors.lastname: Dombrowski
mesh_terms: D000328:Adult; D016022:Case-Control Studies; D003266:Continuity of Patient Care; D005260:Female; D015658:HIV Infections / Q000188:drug therapy*; D006297:Health Services Accessibility; D006301:Health Services Needs and Demand; D006801:Humans; D008297:Male; D008875:Middle Aged; D011159:Population Surveillance; D011634:Public Health