HIV retention in care: results and lessons learned from the Positive Pathways Implementation Trial
Abstract Background Sustained, routine care is vital to the health of people with HIV (PWH) and decreasing transmission of HIV. We evaluated whether the identification of PWH at-risk of falling out of care and prompts for outreach were effective in retaining PWH in care in the United States. Methods...
| Main Authors: | , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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BMC
2022-11-01
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| Series: | BMC Primary Care |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s12875-022-01909-2 |
| _version_ | 1828119770853015552 |
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| author | Michael B. Wohlfeiler Rachel Palmieri Weber Laurence Brunet Jennifer S. Fusco Christine Uranaka Quateka Cochran Monica Palma Tammeka Evans Carl Millner Gregory P. Fusco |
| author_facet | Michael B. Wohlfeiler Rachel Palmieri Weber Laurence Brunet Jennifer S. Fusco Christine Uranaka Quateka Cochran Monica Palma Tammeka Evans Carl Millner Gregory P. Fusco |
| author_sort | Michael B. Wohlfeiler |
| collection | DOAJ |
| description | Abstract Background Sustained, routine care is vital to the health of people with HIV (PWH) and decreasing transmission of HIV. We evaluated whether the identification of PWH at-risk of falling out of care and prompts for outreach were effective in retaining PWH in care in the United States. Methods In this cluster randomized controlled trial, 20 AIDS Healthcare Foundation Healthcare Centers (HCCs) were randomized to the intervention (n = 10) or control (n = 10) arm; all maintained existing retention efforts. The intervention included daily automated flags in CHORUS™, a mobile app and web-based reporting solution utilizing electronic health record data, that identified PWH at-risk of falling out of care to clinic staff. Among flagged PWH, the association between the intervention and visits after a flag was assessed using logistic regression models fit with generalized estimating equations (independent correlation structure) to account for clustering. To adjust for differences between HCCs, models included geographic region, number of PWH at HCC, and proportions of PWH who self-identified as Hispanic or had the Ryan White Program as a payer. Results Of 15,875 PWH in care, 56% were flagged; 76% (intervention) and 75% (control) resulted in a visit, of which 76% were within 2 months of the flag. In adjusted analyses, flags had higher odds of being followed by a visit (odds ratio [OR]: 1.08, 95% confidence interval [CI]: 0.97, 1.21) or a visit within 2 months (OR: 1.07, 95% CI: 0.97, 1.17) at intervention than control HCCs. Among at-risk PWH with viral loads at baseline and study end, the proportion with < 50 copies/mL increased in both study arms, but more so at intervention (65% to 74%) than control (62% to 67%) HCCs. Conclusion Despite challenges of the COVID-19 pandemic, adding an intervention to existing retention efforts, and the reality that behavior change takes time, PWH flagged as at-risk of falling out of care were marginally more likely to return for care at intervention than control HCCs and a greater proportion achieved undetectability. Sustained use of the retention module in CHORUS™ has the potential to streamline retention efforts, retain more PWH in care, and ultimately decrease transmission of HIV. Trial Registration The study was first registered at Clinical Trials.gov (NCT04147832, https://clinicaltrials.gov/show/NCT04147832 ) on 01/11/2019. |
| first_indexed | 2024-04-11T13:53:22Z |
| format | Article |
| id | doaj.art-02cacf5a919b41b091d90b74a94ef6e6 |
| institution | Directory Open Access Journal |
| issn | 2731-4553 |
| language | English |
| last_indexed | 2024-04-11T13:53:22Z |
| publishDate | 2022-11-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Primary Care |
| spelling | doaj.art-02cacf5a919b41b091d90b74a94ef6e62022-12-22T04:20:25ZengBMCBMC Primary Care2731-45532022-11-012311810.1186/s12875-022-01909-2HIV retention in care: results and lessons learned from the Positive Pathways Implementation TrialMichael B. Wohlfeiler0Rachel Palmieri Weber1Laurence Brunet2Jennifer S. Fusco3Christine Uranaka4Quateka Cochran5Monica Palma6Tammeka Evans7Carl Millner8Gregory P. Fusco9AIDS Healthcare FoundationEpividian Inc.Epividian Inc.Epividian Inc.AIDS Healthcare FoundationAIDS Healthcare FoundationAIDS Healthcare FoundationViiV HealthcareAIDS Healthcare FoundationEpividian Inc.Abstract Background Sustained, routine care is vital to the health of people with HIV (PWH) and decreasing transmission of HIV. We evaluated whether the identification of PWH at-risk of falling out of care and prompts for outreach were effective in retaining PWH in care in the United States. Methods In this cluster randomized controlled trial, 20 AIDS Healthcare Foundation Healthcare Centers (HCCs) were randomized to the intervention (n = 10) or control (n = 10) arm; all maintained existing retention efforts. The intervention included daily automated flags in CHORUS™, a mobile app and web-based reporting solution utilizing electronic health record data, that identified PWH at-risk of falling out of care to clinic staff. Among flagged PWH, the association between the intervention and visits after a flag was assessed using logistic regression models fit with generalized estimating equations (independent correlation structure) to account for clustering. To adjust for differences between HCCs, models included geographic region, number of PWH at HCC, and proportions of PWH who self-identified as Hispanic or had the Ryan White Program as a payer. Results Of 15,875 PWH in care, 56% were flagged; 76% (intervention) and 75% (control) resulted in a visit, of which 76% were within 2 months of the flag. In adjusted analyses, flags had higher odds of being followed by a visit (odds ratio [OR]: 1.08, 95% confidence interval [CI]: 0.97, 1.21) or a visit within 2 months (OR: 1.07, 95% CI: 0.97, 1.17) at intervention than control HCCs. Among at-risk PWH with viral loads at baseline and study end, the proportion with < 50 copies/mL increased in both study arms, but more so at intervention (65% to 74%) than control (62% to 67%) HCCs. Conclusion Despite challenges of the COVID-19 pandemic, adding an intervention to existing retention efforts, and the reality that behavior change takes time, PWH flagged as at-risk of falling out of care were marginally more likely to return for care at intervention than control HCCs and a greater proportion achieved undetectability. Sustained use of the retention module in CHORUS™ has the potential to streamline retention efforts, retain more PWH in care, and ultimately decrease transmission of HIV. Trial Registration The study was first registered at Clinical Trials.gov (NCT04147832, https://clinicaltrials.gov/show/NCT04147832 ) on 01/11/2019.https://doi.org/10.1186/s12875-022-01909-2HIVHIV Treatment and PreventionRetention in CareRe-engagementAlertsClinical Decision Support System |
| spellingShingle | Michael B. Wohlfeiler Rachel Palmieri Weber Laurence Brunet Jennifer S. Fusco Christine Uranaka Quateka Cochran Monica Palma Tammeka Evans Carl Millner Gregory P. Fusco HIV retention in care: results and lessons learned from the Positive Pathways Implementation Trial BMC Primary Care HIV HIV Treatment and Prevention Retention in Care Re-engagement Alerts Clinical Decision Support System |
| title | HIV retention in care: results and lessons learned from the Positive Pathways Implementation Trial |
| title_full | HIV retention in care: results and lessons learned from the Positive Pathways Implementation Trial |
| title_fullStr | HIV retention in care: results and lessons learned from the Positive Pathways Implementation Trial |
| title_full_unstemmed | HIV retention in care: results and lessons learned from the Positive Pathways Implementation Trial |
| title_short | HIV retention in care: results and lessons learned from the Positive Pathways Implementation Trial |
| title_sort | hiv retention in care results and lessons learned from the positive pathways implementation trial |
| topic | HIV HIV Treatment and Prevention Retention in Care Re-engagement Alerts Clinical Decision Support System |
| url | https://doi.org/10.1186/s12875-022-01909-2 |
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