title: Assessing efficacy of a retention-in-care intervention among HIV patients with depression, anxiety, heavy alcohol consumption and illicit drug use.
abstract: OBJECTIVE
  We evaluated whether heavy alcohol use, illicit drug use or high levels of anxiety, and depression symptoms were modifiers of the retention through enhanced personal contact intervention. The intervention had previously demonstrated overall efficacy in the parent study.
  
  
  METHODS
  Randomized trial.
  
  
  METHODS
  A total of 1838 patients from six US HIV clinics were enrolled into a randomized trial in which intervention patients received an 'enhanced contact' protocol for 12 months. All participants completed an audio computer-assisted self-interview that measured depression and anxiety symptoms from the Brief Symptom Inventory, alcohol use from the Alcohol Use Disorders Identification Test-Consumption instrument, and drug use from the WHO (Alcohol, Smoking and Substance Involvement Screening Test) questions. The 12-month binary outcome was completing an HIV primary care visit in three consecutive 4-month intervals. The outcome was compared between intervention and standard of care patients within subgroups on the effect modifier variables using log-binomial regression models.
  
  
  RESULTS
  Persons with high levels of anxiety or depression symptoms and those reporting illicit drug use, or heavy alcohol consumption had no response to the intervention. Patients without these 'higher risk' characteristics responded significantly to the intervention. Further analysis revealed higher risk patients were less likely to have successfully received the telephone contact component of the intervention. Among higher risk patients who did successfully receive this component, the intervention effect was significant.
  
  
  CONCLUSIONS
  Our findings suggest that clinic-based retention-in-care interventions are able to have significant effects on HIV patients with common behavioral health issues, but the design of those interventions should assure successful delivery of intervention components to increase effectiveness.
authors.affiliation: aDivision of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia bDepartment of Medicine, Baylor College of Medicine, Center for Innovations in Quality, Effectiveness, and Safety, Michael E. DeBakey VA Medical Center cDepartment of Psychiatry, University of Texas at Houston School of Medicine, Houston dDepartment of Medicine, Baylor College of Medicine, Medical Director of HIV Services, Thomas Street Health Center and Harris Health System, Center for Innovations in Quality, Effectiveness, and Safety, Michael E. DeBakey VA Medical Center, Houston, Texas eDepartment of Community Health Sciences School of Public Health, State University of New York, Downstate Medical Center, Brooklyn, New York fDepartment of Health Policy and Management, Boston University School of Public Health, Center for Healthcare Organization and Implementation Research, Edith Nourse Rogers Memorial VA Hospital gDepartment of Medicine, Boston University School of Medicine, Boston, Massachusetts hDepartment of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland iResearch and Informatics Service Center (RISC), University of Alabama-Birmingham, Birmingham, Alabama jDepartment of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, USA.
authors.forename: Lytt I
authors.initials: LI
authors.lastname: Gardner
authors.forename: Gary
authors.initials: G
authors.lastname: Marks
authors.forename: Lokesh
authors.initials: L
authors.lastname: Shahani
authors.forename: Thomas P
authors.initials: TP
authors.lastname: Giordano
authors.forename: Tracey E
authors.initials: TE
authors.lastname: Wilson
authors.forename: Mari-Lynn
authors.initials: ML
authors.lastname: Drainoni
authors.forename: Jeanne C
authors.initials: JC
authors.lastname: Keruly
authors.forename: David Scott
authors.initials: DS
authors.lastname: Batey
authors.forename: Lisa R
authors.initials: LR
authors.lastname: Metsch
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000437:Alcoholism / Q000150:complications*; D001007:Anxiety / Q000150:complications*; D001521:Behavior Therapy / Q000379:methods; D002648:Child; D003863:Depression / Q000150:complications*; D015658:HIV Infections / Q000150:complications* / Q000188:drug therapy*; D006801:Humans; D008297:Male; D055118:Medication Adherence; D008875:Middle Aged; D019966:Substance-Related Disorders / Q000150:complications*; D016896:Treatment Outcome; D014481:United States; D055815:Young Adult