title: HIV patient retention: the implementation of a North Carolina clinic-based protocol.
abstract: Decreased visit attendance leads to poor health outcomes, decreased viral suppression, and higher mortality rates for persons living with HIV. Retention in care is an important factor in improving health status for people living with HIV but continues to be a challenge in clinical settings. This paper details the development and implementation of the NC-LINK Retention Protocol, a clinic-based protocol to locate and reengage out-of-care patients, as part of overall clinic retention efforts. The protocol was implemented as one of four interventions of the NC-LINK Systems and Linkages Project, a multi-site initiative funded by the HIV/AIDS Bureau and the Special Projects of National Significance. Lists of out-of-care patients who had not received HIV medical care in over nine months and did not have a future appointment were created each month. Patient navigators, case managers, and other staff then followed a standardized protocol to locate and reengage these patients in care. A total of 452 patients were identified for reengagement services. Of those, 194 (43%) returned to care, 108 (24%) had another definitive outcome (incarcerated, deceased, or relocated) and 150 (33%) were referred for additional follow-up to locate and reengage in care. In summary, 67% of patients were located through the efforts of the clinic staff. The results of this intervention indicate that it is possible to successfully integrate a protocol into the existing infrastructure of a clinic and reengage a majority of out-of-care patients into medical care.
authors: a Section on Infectious Diseases , Wake Forest University School of Medicine , Winston-Salem , NC , USA.
authors: Jennifer
authors: J
authors: Keller
authors: b Institute for Global Health and Infectious Diseases , University of North Carolina at Chapel Hill , Chapel Hill , NC , USA.
authors: Amy
authors: A
authors: Heine
authors: b Institute for Global Health and Infectious Diseases , University of North Carolina at Chapel Hill , Chapel Hill , NC , USA.
authors: Anna Finestone
authors: AF
authors: LeViere
authors: c Communicable Disease Branch, North Carolina Department of Health and Human Services , Raleigh , NC , USA.
authors: Jenna
authors: J
authors: Donovan
authors: a Section on Infectious Diseases , Wake Forest University School of Medicine , Winston-Salem , NC , USA.
authors: Aimee
authors: A
authors: Wilkin
authors: d Center for Health Policy and Inequalities Research , Duke Global Health Institute, Duke University , Durham , NC , USA.
authors: Kristen
authors: K
authors: Sullivan
authors: b Institute for Global Health and Infectious Diseases , University of North Carolina at Chapel Hill , Chapel Hill , NC , USA.
authors: Evelyn Byrd
authors: EB
authors: Quinlivan
mesh_terms: D000293:Adolescent; D000328:Adult; D000554:Ambulatory Care Facilities / Q000458:organization & administration*; D001071:Appointments and Schedules; D005260:Female; D015658:HIV Infections / Q000188:drug therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009657:North Carolina; D010352:Patient Dropouts; D055815:Young Adult
keywords: HIV; clinic; patient care; reengagement; retention