Enhanced HIV Patient Contact Improves Visit Adherence in US

Doctor counsels patient

Taking specific steps to increase contact with HIV patients improved clinic visit consistency and visit adherence in a randomized trial at 6 US clinics. Additional training for HIV providers did not further promote appointment keeping.

Once HIV-positive people begin care for their infection, keeping appointments and staying in care remain a challenge for many throughout the world. Clinicians and researchers in the United States tested the impact of two interventions on retention in care in people with a recent history of inconsistent clinic attendance and in new HIV patients at 6 clinics.

The research team randomized people to one of three arms: standard of care, enhanced contact, and enhanced contact plus brief skills training. Enhanced contact included brief face-to-face meetings with each return visit, between-visit phone calls, appointment reminder calls, and missed visit calls. Skills training focused on organization, problem solving, and communications skills.

Outcomes measured after 12 months were visit consistency (percentage of participants attending at least 1 primary care visit in 3 consecutive 4-month intervals) and visit adherence (proportion of kept/scheduled primary care visits).

Compared with the standard of care, enhanced contact and enhanced contact plus skills training each improved visit consistency 22% (risk ratio [RR] 1.22, 95% confidence interval [CI] 1.09 to 1.36 for both). Enhanced contact improved visit adherence 8% (RR 1.08, 95% CI 1.05 to 1.11), while enhanced contact plus skills training improved visit adherence 6% (RR 1.06, 95% CI 1.02 to 1.09).

The interventions had a lower impact on HIV patients who reported using illicit drugs or who reported unmet needs.

The researchers conclude that "enhanced contact with patients improved retention in HIV primary care compared with existing standard-of-care practices," but "a brief patient skill-building component did not improve retention further."

Source: Lytt I. Gardner, Thomas P. Giordano, Gary Marks, Tracey E. Wilson, Jason A. Craw, Mari-Lynn Drainoni, Jeanne C. Keruly, Allan E. Rodriguez, Faye Malitz, Richard D. Moore, Lucy A. Bradley-Springer, Susan Holman, Charles E. Rose, Sonali Girde, Meg Sullivan, Lisa R. Metsch, Michael Saag, Michael J. Mugavero, for the Retention in Care Study Group. Enhanced personal contact with hiv patients improves retention in primary care: a randomized trial in 6 US HIV clinics. Clinical Infectious Diseases. 2014; 59: 725-734.

Written by Mark Mascolini on behalf of the International AIDS Society