Enhanced Personal Contact With HIV Patients Improves Retention in Primary Care: A Randomized Trial in 6 US HIV Clinics

Self Cite

Lack of trust by the patient in the physicians or the healthcare system has been associated with poorer health outcomes. The present study was designed to determine if trust in physicians and the healthcare system among persons newly diagnosed with HIV infection was predictive of patients' subsequent linkage, retention, and adherence to HIV care. 178 newly diagnosed HIV infected patients were administered the trust-in-physicians and trust-in-healthcare system scales. Median trust-in-physicians and trust-in-healthcare system scores were compared for all the mentioned subsequent linkage, retention, and adherence to HIV care. Univariate logistic regression using the trust-in-physician scale confirmed significant association with retention in care ( p = 0.04), which persisted in multivariate analyses ( p = 0.04). No significant association was found between trust-inphysicians and linkage to care or adherence to antiretroviral therapy. Trust in the healthcare system was not associated with any of the outcomes. Patients with higher trust in physicians were more likely to be retained in HIV care. Trust at diagnosis may not be a barrier to better clinical outcomes, either because trust changes based on subsequent interactions, or because trust is not a determining feature. Interventions to improve retention in care could include improving trust in physicians or target persons with low trust in physicians.

Section: Discussionmentioning

confidence: 99%

The Influence of Trust in Physicians and Trust in the Healthcare System on Linkage, Retention, and Adherence to HIV Care

Graham

Shahani

Grimes

et al. 2015

Self Cite

“…[28][29][30][31][32] Given the increasing pressure to manage large panels of complex patients in a manner that produces optimal outcomes with minimal use of resources, identifying ways to conduct population-level triage remains critical. In addition to predicting the magnitude of risk for missing the next appointment, this tool stratified a large cohort of over 500 patients with unsuppressed viremia based on severity of risk.…”

Section: Discussionmentioning

confidence: 99%

“…Therefore, this study sought to determine whether a tool previously operationalized to stratify patients according to virologic failure risk at 1 year 27 could also stratify patients based on the risk of a related and potentially more immediate event: missing their next HIV primary care visit. Systematic risk assessment could support targeting of limited resources and interventions shown to improve engagement in care, such as enhanced case management, [28][29][30] to those at highest risk.…”

Section: Aids Patient Care and Stdsmentioning

confidence: 99%

Risk Prediction Tool for Medical Appointment Attendance Among HIV-Infected Persons with Unsuppressed Viremia

Woodward

Person²,

Rebeiro³

et al. 2015

Successful treatment of HIV infection requires regular clinical follow-up. A previously published risk-prediction tool (RPT) utilizing data from the electronic health record (EHR) including medication adherence, previous appointment attendance, substance abuse, recent CD4 + count, prior antiretroviral therapy (ART) exposure, prior treatment failure, and recent HIV-1 viral load (VL) has been shown to predict virologic failure at 1 year. If this same tool could be used to predict the more immediate event of appointment attendance, high-risk patients could be identified and interventions could be targeted to improve this outcome. We conducted an observational cohort study at the Vanderbilt Comprehensive Care Clinic from August 2013 through March 2014. Patients with routine medical appointments and most recent HIV-1 VL > 200 copies/mL were included. Risk scores for a modified RPT were calculated based on data from the EHR. Odds ratios (OR) for missing the next appointment were estimated using multivariable logistic regression. Among 510 persons included, median age was 39 years, 74% were male, 55% were black, median CD4 + count was 327 cells/mm 3 [Interquartile Range (IQR): 142-560], and median HIV-1 VL was 21,818 copies/mL (IQR: 2,030-69,597). Medium [OR 3.95, 95% confidence interval (CI) 2.08-7.50, p-value < 0.01] and high (OR 9.55,, p-value < 0.01) vs. low RPT risk scores were independently associated with missing the next appointment. RPT scores, constructed using readily available data, allow for risk-stratification of HIV medical appointment non-attendance and could support targeting limited resources to improve appointment adherence in groups most at-risk of poor HIV outcomes.

“…The length and continuity of care through attending the same HIV care center over long periods of time may help a positive trusting relationship to develop, thereby facilitating disclosure. 60 Recommendation #3. Any healthcare provider with an established trust relationship can inquire about IPV Henderson and colleague suggest that a healthcare worker of the same sex is preferable when asking about IPV, 61 while research on IPV screening protocols in reproductive health clinics found that a male inquiring about IPV and a health care provider other than an obstetrician/gynecologist were noted as barriers to disclosure.…”

Section: Recommendation #2 a ''Trust Relationship With The Patient''mentioning

confidence: 99%

Implementing an Intimate Partner Violence (IPV) Screening Protocol in HIV Care

Raissi

Krentz

Siemieniuk

et al. 2015

HIV and intimate partner violence (IPV) epidemics propagate and interact in a syndemic fashion contributing to excess burden of disease and poorer health outcomes. In order to understand the impact of IPV on HIV disease management, a universal screening program was implemented in the Southern Alberta Clinic in May 2009. We evaluated our IPV screening protocol and made recommendations for its usage in HIV care. IPV data obtained from patients were evaluated, supplemented with responses from a subset of in-depth interviews. 35% of 1721 patients reported experiencing IPV. Prevalence was higher among females (46%), Aboriginal Canadians (67%), bisexual male/females (48%), and gay males (35%). Of 158 patients interviewed, only 22% had previously been asked about IPV in any health care setting. Patients were responsive to routine IPV screening emphasizing that referral services need to be easily accessible. 23% of patients disclosing IPV subsequently connected to additional IPV resources after screening. We recommend that universal IPV screening be incorporated within regular HIV clinic care. The IPV survey should be given after trust has been established with regular follow-up every 6-12 months. A referral process to local agencies dealing with IPV must be in place for patients disclosing abuses.