A Cluster Randomized Evaluation of a Health Department Data to Care Intervention Designed to Increase Engagement in HIV Care and Antiretroviral Use

Dombrowski, Julia C.; Buskin, Susan E.; Bennett, Amy; Katz, David A.; Fleming, Mark T.; Nunez, Angela; Golden, Matthew R.

doi:10.1097/olq.0000000000000760

Cited by 27 publications

(44 citation statements)

References 21 publications

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“…Importantly, there was no control group, and we cannot compare our results to an expected change in viral suppression that would have occurred without our efforts. To date, controlled evaluations of the effect of navigation on retention and suppression outcomes have had null results [ 12 , 24 , 25 ]. There are data to support that many PWH “churn” in and out of care, and the cyclical return to care could be contributing to the change we observed [ 26 ].…”

Section: Discussionmentioning

confidence: 99%

“…The goal of D2C is to identify people who are NIC based on the absence of reportable HIV-related lab values such as viral load and CD4 cell count and assign them to an HIV navigator, who then works to locate them, offer services, and assist with linkage to HIV care [ 8 ]. Implementation of D2C varies across jurisdictions, and published reports describe successful re-linkage outcomes from 3 main D2C referral sources: (1) health care providers [ 9–11 ], (2) HIV surveillance [ 12–16 ], and (3) a combination approach in which a list of patients lost to follow-up from an HIV care clinic is matched to HIV surveillance [ 3 , 6 , 17–19 ]. Several jurisdictions cite inefficiencies of surveillance-only-generated referrals because of the overidentification of “current to care” PWH who appear to be NIC by surveillance because of delayed lab reporting or relocation across state lines [ 11 , 13 , 14 , 16 , 20 , 21 ].…”

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confidence: 99%

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“Is a Bird in the Hand Worth 5 in the Bush?”: A Comparison of 3 Data-to-Care Referral Strategies on HIV Care Continuum Outcomes in San Francisco

Sachdev

Mara

Hughes

et al. 2020

Open Forum Infectious Diseases

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BACKGROUND Health departments utilize HIV surveillance data to identify people living with HIV (PWH) who need re-linkage to HIV care as part of an approach known as Data to Care (D2C.) The most accurate, effective and efficient method of identifying PWH for re-linkage is unknown. METHODS We evaluated referral and care continuum outcomes among PWH identified using three D2C referral strategies: health care providers, surveillance, and a combination list derived by matching an electronic medical record registry to HIV surveillance. PWH who were enrolled in the re-linkage intervention received short-term case management for up to 90 days. Relative risks and 95% confidence intervals were calculated to compare proportions of PWH retained and virally suppressed before and after re-linkage. Durable viral suppression was defined as having suppressed viral loads at all viral load measurement in 12 months after re-linkage. RESULTS After initial investigation, 233 (24%) of 954 referrals were located and enrolled in navigation. Although the number of surveillance and provider referrals were similar, 72% of enrolled PWH were identified by providers, 16% by surveillance and 12% by combination list. Overall, retention and viral suppression improved, although relative increases in retention and viral suppression were only significant among individuals identified by surveillance or providers. Seventy percent of PWH who achieved viral suppression after the intervention remained durably virally suppressed. CONCLUSIONS PWH referred by providers were most likely to be located and enrolled in navigation than PWH identified by surveillance or combination lists. Overall, D2C re-linkage efforts improved retention, viral suppression and durable viral suppression.

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Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

“Is a Bird in the Hand Worth 5 in the Bush?”: A Comparison of 3 Data-to-Care Referral Strategies on HIV Care Continuum Outcomes in San Francisco

Sachdev

Mara

Hughes

et al. 2020

Open Forum Infectious Diseases

View full text Add to dashboard Cite

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“…Health department Data to Care efforts have been limited by inaccuracies in HIV surveillance data and low levels of successful contact with individual PLWH. 8,[15][16][17][18] Moreover, most Data to Care interventions focus on relinkage to care (completing one visit) rather than achieving sustained engagement in care or achieving viral suppression. Several reports describe care coordination and case management approaches to engaging hard-to-reach PLWH.…”

Section: Discussionmentioning

confidence: 99%

“…We undertook this work after implementing and evaluating two strategies to reengage patients in HIV care that proved to be ineffective. The first was a health department Data to Care intervention 4,7,8 that showed no impact on relinkage to care or viral suppression in a randomized controlled evaluation. 8 The second was a clinic-based patient retracing strategy that improved relinkage to care compared to a historical control, 9 but the effect size was small (15% vs. 10%), and the intervention did not significantly impact viral suppression.…”

Section: Introductionmentioning

confidence: 99%

“…The first was a health department Data to Care intervention 4,7,8 that showed no impact on relinkage to care or viral suppression in a randomized controlled evaluation. 8 The second was a clinic-based patient retracing strategy that improved relinkage to care compared to a historical control, 9 but the effect size was small (15% vs. 10%), and the intervention did not significantly impact viral suppression. Based on these experiences, we concluded that strategies focused on relinking patients to the same healthcare system that failed to engage them in the first place are unlikely to make a substantial public health impact.…”

Section: Introductionmentioning

confidence: 99%

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The Max Clinic: Medical Care Designed to Engage the Hardest-to-Reach Persons Living with HIV in Seattle and King County, Washington

Dombrowski

Ramchandani

Dhanireddy

et al. 2018

AIDS Patient Care and STDs

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The Max Clinic in Seattle, Washington is designed to engage patients who have extensive barriers to HIV care. In this article, we describe the clinic's evolution and outcomes of patients enrolled in the first 2 years. The clinic is a high-intensity, low-threshold, incentivized care model that includes walk-in access to primary care in a Sexually Transmitted Disease Clinic. Patients who have failed to engage in care and achieve viral suppression with lower intensity support are referred by clinicians, case managers, and the health department Data to Care program. The clinic offers food vouchers, cash incentives, no-cost bus passes, and cell phones, as well as intensive case management with cross-agency coordinated care. The primary evaluation outcome was the percentage of patients who achieved viral suppression (HIV RNA <200 copies/mL) at least once after enrollment. Secondary outcomes were continuous viral suppression (≥2 suppressed results in a row ≥60 days apart) and engagement in care (≥2 completed medical visits ≥60 days apart). During January 2015-December 2016, 263 patients were referred; 170 (65%) were eligible, and 95 (56% of eligible) were enrolled. Most patients used illicit drugs or hazardous levels of alcohol (86%) and had diagnosed psychiatric illness (72%) and unstable housing (65%). During the year after enrollment, 90 (95%) patients engaged in care. As of the end of 2016, 76 (80%) had achieved viral suppression, and 54% had continuous viral suppression. The Max Clinic successfully treated HIV in high-need patients and, to date, has been sustainable through a combination of federal, state, and local funding.

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Costs and cost‐effectiveness of a collaborative data‐to‐care intervention for HIV treatment and care in the United States

et al. 2023

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Introduction Data‐to‐care programmes utilize surveillance data to identify persons who are out of HIV care, re‐engage them in care and improve HIV care outcomes. We assess the costs and cost‐effectiveness of re‐engagement in an HIV care intervention in the United States. Methods The Cooperative Re‐engagement Control Trial (CoRECT) employed a data‐to‐care collaborative model between health departments and HIV care providers, August 2016–July 2018. The health departments in Connecticut (CT), Massachusetts (MA) and Philadelphia (PHL) collaborated with HIV clinics to identify newly out‐of‐care patients and randomize them to receive usual linkage and engagement in care services (standard‐of‐care control arm) or health department‐initiated active re‐engagement services (intervention arm). We used a microcosting approach to identify the activities and resources involved in the CoRECT intervention, separate from the standard‐of‐care, and quantified the costs. The cost data were collected at the start‐up and recurrent phases of the trial to incorporate potential variation in the intervention costs. The costs were estimated from the healthcare provider perspective. Results The CoRECT trial in CT, MA and PHL randomly assigned on average 327, 316 and 305 participants per year either to the intervention arm (n = 166, 159 and 155) or the standard‐of‐care arm (n = 161, 157 and 150), respectively. Of those randomized, the number of participants re‐engaged in care within 90 days in the intervention and standard‐of‐care arms was 85 and 70 in CT, 84 and 70 in MA, and 98 and 67 in PHL. The additional number of participants re‐engaged in care in the intervention arm compared with those in the standard‐of‐care arm was 15 (CT), 14 (MA) and 31 (PHL). We estimated the annual total cost of the CoRECT intervention at $490,040 in CT, $473,297 in MA and $439,237 in PHL. The average cost per participant enrolled was $2952, $2977 and $2834 and the average cost per participant re‐engaged in care was $5765, $5634 and $4482. We estimated an incremental cost per participant re‐engaged in care at $32,669 (CT), $33,807 (MA) and $14,169 (PHL). Conclusions The costs of the CoRECT intervention that identified newly out‐of‐care patients and re‐engaged them in HIV care are comparable with other similar interventions, suggesting a potential for its cost‐effectiveness in the US context.

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A Cluster Randomized Evaluation of a Health Department Data to Care Intervention Designed to Increase Engagement in HIV Care and Antiretroviral Use

Abstract: The Data to Care intervention did not impact time to viral suppression.

Cited by 27 publications

References 21 publications

“Is a Bird in the Hand Worth 5 in the Bush?”: A Comparison of 3 Data-to-Care Referral Strategies on HIV Care Continuum Outcomes in San Francisco

“Is a Bird in the Hand Worth 5 in the Bush?”: A Comparison of 3 Data-to-Care Referral Strategies on HIV Care Continuum Outcomes in San Francisco

The Max Clinic: Medical Care Designed to Engage the Hardest-to-Reach Persons Living with HIV in Seattle and King County, Washington

Costs and cost‐effectiveness of a collaborative data‐to‐care intervention for HIV treatment and care in the United States

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