Development and application of a new measure of engagement in out‐patient <scp>HIV</scp> care

Howarth, A; Burns, F; Apea,; José, Sophie; Hill, Teresa; Delpech, Valérie; Evans, Amanda; Mercer, Catherine H; Michie, Susan; Morris, Steve; Sachikonye, Memory; Sabin, Caroline

doi:10.1111/hiv.12427

Cited by 18 publications

(28 citation statements)

References 20 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…A greater frequency of medical contacts when initiating treatment increases opportunities for providing targeted support for engagement in HIV care to newly diagnosed patients facing social or administrative barriers. In contrast to our findings, in both a Spanish and an English study, recently diagnosed patients had fewer missed medical appointments [25,30], but these studies did not examine retention in HIV care over a long period.…”

Section: Discussioncontrasting

confidence: 99%

“…We used a definition of 1 year without an HIV care record to allow some flexibility for stable patients spacing their appointments while remaining properly followed up. Various metrics have been used to study regularity of HIV care, each with its own strengths and weaknesses [30,38]. Our definition is relevant for an epidemiological approach to HCI and its predictors.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Incidence rate, predictors and outcomes of interruption of HIV care: nationwide results from the Belgian HIV cohort

et al. 2020

View full text Add to dashboard Cite

Objectives We aimed to study the incidence rate, predictors and outcomes of HIV care interruption (HCI) in Belgium. Methods We analysed data for adult patients with at least two HIV care records in the Belgian HIV cohort between 1 January 2007 and 31 December 2016. An HCI episode was defined as 1 year without an HIV care record. The HCI incidence rate was analysed using Poisson regression, return to HIV care using a cumulative incidence function with death as a competing risk, and viral load (VL) status upon return to HIV care using logistic regression. Results We included 16 066 patients accounting for 78 625 person‐years of follow‐up. The incidence rate of HCI was 5.3/100 person‐years [95% confidence interval (CI) 5.1–5.4/100 person‐years]. The incidence of return to HIV care after HCI was estimated at 77.5% (95% CI 75.7–79.2%). Of those who returned to care, 43.7% had a VL ≤ 200 HIV‐1 RNA copies/mL, suggesting care abroad or suboptimal care (without an HIV‐related care record) in Belgium during the HCI, and 56.3% returned without controlled VL and were therefore considered as having experienced a real gap in HIV care; they represented 2.3/100 person‐years of follow‐up. Factors individually associated with HCI were no antiretroviral therapy (ART) uptake, lower age, injecting drug use, non‐Belgian nationality, male gender, not being a man who has sex with men, a shorter time since HIV diagnosis, no high blood pressure and CD4 count < 350 cells/µL. Conclusions This study highlights the need to investigate return to care and viral status at return, to better understand HCI. Identified predictors can help health care workers to target patients at higher risk of HCI for awareness and support.

show abstract

Section: Discussioncontrasting

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Incidence rate, predictors and outcomes of interruption of HIV care: nationwide results from the Belgian HIV cohort

et al. 2020

View full text Add to dashboard Cite

show abstract

“…Future studies may also consider the use of patient-centered measures of engagement in care. 51 The current study also supports a growing body of literature on the specific effects of internalized stigma from studies conducted in samples from other U.S. regions.…”

Section: Discussionsupporting

confidence: 81%

Association Between Internalized HIV-Related Stigma and HIV Care Visit Adherence

Rice

Crockett

Mugavero

et al. 2017

JAIDS Journal of Acquired Immune Deficiency Syndromes

View full text Add to dashboard Cite

Background Internalized HIV-related stigma acts as a barrier to antiretroviral therapy (ART) adherence, but its effects on other HIV care continuum outcomes is unclear. Methods Among 196 HIV clinic patients in Birmingham, Alabama, we assessed internalized HIV-related stigma and depressive symptom severity using validated multi-item scales, and assessed ART adherence using a validated single-item measure. HIV visit adherence (attended out of total scheduled visits) was calculated using data from clinic records. Using covariate-adjusted regression analysis, we investigated the association between internalized stigma and visit adherence. Using path analytic methods with bootstrapping, we tested the mediating role of depressive symptoms in the association between internalized stigma and visit adherence, and the mediating role of visit adherence in the association between internalized stigma and ART adherence. Results Higher internalized stigma was associated with lower visit adherence (B=−0.04, p=0.04). Black (versus white) race and depressive symptoms were significant predictors within this model. Mediation analysis yielded no effect by depression in the association between internalized stigma and visit adherence (B = −0.18, SE = .11, 95% CI [−0.44, −0.02]) in the whole sample. Supplemental mediated moderation analyses revealed gender-specific effects. Additionally, the indirect effect of internalized stigma on sub-optimal ART adherence was mediated by lower visit adherence (B = −0.18, SE = .11, 95% CI [−0.44, −0.02]). Conclusion Results highlight the importance of internalized HIV stigma to multiple and sequential HIV care continuum outcomes. Also, findings suggest multiple intervention targets, including addressing internalized stigma directly, reducing depressive symptoms, and promoting consistent engagement in care.

show abstract

“…b Blips are defined as having a viral load of between 50 and 200 copies/ml following a previous viral load of < 50 copies/ml. Adapted from Howarth et al 44 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.…”

Section: Development Of Engagement In Care Algorithmmentioning

confidence: 99%

REACH: a mixed-methods study to investigate the measurement, prediction and improvement of retention and engagement in outpatient HIV care

Howarth

Apea

Michie

et al. 2017

Health Serv Deliv Res

View full text Add to dashboard Cite

BackgroundAntiretroviral therapy (ART) benefits individuals living with human immunodeficiency virus (HIV) through reduced morbidity and mortality, and brings public health gains through a reduction in HIV transmission. People living with human immunodeficiency virus (PLWH) need to know their HIV status and engage in HIV care in order for these individual and public health benefits to be realised.ObjectiveTo explore, describe and understand HIV outpatient attendance in PLWH, in order to develop cost-effective interventions to optimise engagement in care.DesignA mixed-methods study incorporating secondary analysis of data from the UK Collaborative HIV Cohort (UK CHIC) study and primary data collection.MethodsPhase 1 – an engagement-in-care (EIC) algorithm was developed to categorise patients as in care or out of care for each month of follow-up. The algorithm was used in group-based trajectory analysis to examine patterns of attendance over time and of the association between the proportion of months in care before ART initiation and post-ART mortality and laboratory test costs. Phase 2 – a cross-sectional survey was conducted among patients attending seven London HIV clinics. Regular attenders (all appointments attended in past year), irregular attenders (one or more appointments missed in past year) and non-attenders (recent absence of ≥ 1 year) were recruited. A ‘retention risk tool’ was developed to identify those at risk of disengaging from care. Individual in-depth interviews and focus groups were conducted with PLWH. Phase 3 – key informant interviews were conducted with HIV service providers. Interventions were developed from the findings of phases 2 and 3.ResultsPlots from group-based trajectory analysis indicated that four trajectories best fitted the data. Higher EIC is associated with reduced mortality but the association between EIC before starting ART, and post-ART mortality [relative hazard (RH) per 10% increase in EIC 0.29, 95% confidence interval (CI) 0.18 to 0.47] was attenuated after adjustment for fixed covariates and post-ART cluster of differentiation 4 counts and viral loads (RH 0.74, 95% CI 0.42 to 1.30). Small differences were found in pre-ART EIC and the costs of post-ART lab tests. The final model for the retention risk tool included age at diagnosis, having children, recreational drug use, drug/alcohol dependency, insufficient money for basic needs and use of public transport to get to the clinic. Quantitative and qualitative data showed that a range of psychological, social and economic issues were associated with disengagement from care. The negative impact of stigma on attendance was highlighted. Interventions were proposed that support a holistic approach to care including peer support, address stigma by holding clinics in alternative locations and involve training staff to encourage attendance.ConclusionsThe study shows the adverse health impacts of disengaging from HIV care and demonstrates the importance of the wider health and social context in managing HIV effectively. Although phase 1 analysis was based on UK data, phases 2 and 3 were limited to London. The interventions proposed are supported by the data but their cost-effectiveness requires testing. Future research is needed to evaluate the interventions, to validate our retention risk tool across populations and settings, and to fully analyse the economic costs of disengaging from HIV care.FundingThe National Institute for Health Research Health Services and Delivery Research programme. The UK CHIC study is funded by the Medical Research Council UK (grant numbers G0000199, G0600337, G0900274 and M004236).

show abstract

Development and application of a new measure of engagement in out‐patient HIV care

Cited by 18 publications

References 20 publications

Incidence rate, predictors and outcomes of interruption of HIV care: nationwide results from the Belgian HIV cohort

Incidence rate, predictors and outcomes of interruption of HIV care: nationwide results from the Belgian HIV cohort

Association Between Internalized HIV-Related Stigma and HIV Care Visit Adherence

REACH: a mixed-methods study to investigate the measurement, prediction and improvement of retention and engagement in outpatient HIV care

Contact Info

Product

Resources

About