Simple Prompts Improve Retention in Care in Six US HIV Clinics

A simple, low-cost intervention significantly improved HIV clinic attendance in a large study at six US clinics, especially among young people and people with high viral loads.

Once HIV-positive people get diagnosed and enter care, staying in care remains a challenge in HIV clinics across the world. To address this problem in the United States, the Centers for Disease Control and Prevention/Health Resources and Services Administration launched the Retention in Care project. The intervention consists of coordinated information via brochures, posters, and verbal messages stressing the importance of regular clinic attendance.

To gauge the impact of this program, researchers at six HIV specialty clinics compared retention in care in 10,018 patients in 2008-2009 (before the intervention began) and in 11,039 patients in 2009-2010 (after the intervention began). Principal outcomes were the percentage of patients who kept two consecutive primary care clinic visits and the average proportion of primary care visits kept.

Compared with the preintervention period, the proportion of patients who kept two consecutive visits improved 7% in the intervention period (P < 0.0001). The average proportion of all primary care appointments that patients kept rose 3% in the intervention period (P < 0.0001).

Both outcomes improved more in younger patients, those with high viral loads, and new or reengaging patients (compared with active patients). Improved attendance by new or reengaging patients was consistent across the six clinics.

The researchers conclude that “targeted messages on staying in care, which were delivered at minimal effort and cost, improved clinic attendance, especially for new or reengaging patients, young patients, and those with elevated viral loads.”

Source: Lytt I. Gardner, Gary Marks, Jason A. Craw, Tracey E. Wilson, Mari-Lynn Drainoni, Richard D. Moore, Michael J. Mugavero, Allan E. Rodriguez, Lucy A. Bradley-Springer, Susan Holman, Jeanne C. Keruly, Meg Sullivan, Paul R. Skolnik, Faye Malitz, Lisa R. Metsch, James L. Raper, Thomas P. Giordano, for the Retention in Care Study Group. A low-effort, clinic-wide intervention improves attendance for HIV primary care. Clinical Infectious Diseases. 2012; 55: 1124-1134.

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Written by Mark Mascolini on behalf of the International AIDS Society