title: Challenges in the Evaluation of Interventions to Improve Engagement Along the HIV Care Continuum in the United States: A Systematic Review.
abstract: In the United States (US), there are high levels of disengagement along the HIV care continuum. We sought to characterize the heterogeneity in research studies and interventions to improve care engagement among people living with diagnosed HIV infection. We performed a systematic literature search for interventions to improve HIV linkage to care, retention in care, reengagement in care and adherence to antiretroviral therapy (ART) in the US published from 2007-mid 2015. Study designs and outcomes were allowed to vary in included studies. We grouped interventions into categories, target populations, and whether results were significantly improved. We identified 152 studies, 7 (5%) linkage studies, 33 (22%) retention studies, 4 (3%) reengagement studies, and 117 (77%) adherence studies. 'Linkage' studies utilized 11 different outcome definitions, while 'retention' studies utilized 39, with very little consistency in effect measurements. The majority (59%) of studies reported significantly improved outcomes, but this proportion and corresponding effect sizes varied substantially across study categories. This review highlights a paucity of assessments of linkage and reengagement interventions; limited generalizability of results; and substantial heterogeneity in intervention types, outcome definitions, and effect measures. In order to make strides against the HIV epidemic in the US, care continuum research must be improved and benchmarked against an integrated, comprehensive framework.
authors.affiliation: Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, 615N. Wolfe St, W6604, Baltimore, MD, 20205, USA. krisher1@jhu.edu.
authors.forename: Kathryn A
authors.initials: KA
authors.lastname: Risher
authors.affiliation: Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
authors.forename: Sunaina
authors.initials: S
authors.lastname: Kapoor
authors.affiliation: Department of Epidemiology, Emory University Rollins School of Public Health, Atlanta, GA, USA.
authors.forename: Alice Moji
authors.initials: AM
authors.lastname: Daramola
authors.affiliation: Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA.
authors.forename: Gabriela
authors.initials: G
authors.lastname: Paz-Bailey
authors.affiliation: Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA.
authors.forename: Jacek
authors.initials: J
authors.lastname: Skarbinski
authors.affiliation: Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA.
authors.forename: Kate
authors.initials: K
authors.lastname: Doyle
authors.affiliation: Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, 615N. Wolfe St, W6604, Baltimore, MD, 20205, USA.
authors.forename: Kate
authors.initials: K
authors.lastname: Shearer
authors.affiliation: Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, 615N. Wolfe St, W6604, Baltimore, MD, 20205, USA.
authors.forename: David
authors.initials: D
authors.lastname: Dowdy
authors.affiliation: Department of Epidemiology, Emory University Rollins School of Public Health, Atlanta, GA, USA.
authors.forename: Eli
authors.initials: E
authors.lastname: Rosenberg
authors.affiliation: Department of Epidemiology, Emory University Rollins School of Public Health, Atlanta, GA, USA.
authors.forename: Patrick
authors.initials: P
authors.lastname: Sullivan
authors.affiliation: Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
authors.forename: Maunank
authors.initials: M
authors.lastname: Shah
mesh_terms: D019380:Anti-HIV Agents / Q000627:therapeutic use*; D019985:Benchmarking; D003266:Continuity of Patient Care; D058872:Epidemics; D015658:HIV Infections / Q000188:drug therapy* / Q000453:epidemiology; D006301:Health Services Needs and Demand; D006801:Humans; D055118:Medication Adherence; D010352:Patient Dropouts; D010358:Patient Participation; D012107:Research Design; D014481:United States / Q000453:epidemiology
chemical_list: D019380:Anti-HIV Agents
keywords: HIV adherence; HIV care continuum; HIV linkage to care; HIV reengagement; HIV retention in care