Improving Engagement in HIV Care Using a Data-to-Care and Patient Navigation System in Louisiana, United States

Abstract

An estimated 57% of persons living with HIV (PLWH) in the United States are not connected to regular medical care or have lapsed from regular care (Centers for Disease Control and Prevention, 2018), increasing risk of HIV progression and transmission and delaying viral suppression. The state of Louisiana has consistently ranked in the top five US states for HIV case rates. We evaluated the impact of a combined data-to-care and patient navigation system that was implemented in 3 cities in Louisiana from 2013 to 2015. The program, LA Links, used a surveillance system to identify PLWH who were not in regular health care and connected them to a patient navigator. During the intervention period, persons who lapsed from care were 17% more likely to reengage in care than persons in the comparison group, and persons newly diagnosed during the intervention period were 56% more likely to link to care.

Strategies to reengage patients lost to follow up in HIV care in high income countries, a scoping review

“…In order to consider patients as LTFU (some articles used the term “out-of-care patients” [ 23 – 28 ] to referred patients disengaged from care but are pending to be confirmed as lost) different time periods were reported in the reviewed literature, including at least six [ 23 , 29 ], nine [ 28 , 30 – 38 ], 12 [ 24 – 27 , 39 – 45 ] and even 14 or 15 months since the last appointment to HIV care, CD4 cell count or viral load test [ 46 , 47 ]. Different strategies to find LTFU patients were reported and, in most articles, they were used simultaneously.…”

“…Different strategies to find LTFU patients were reported and, in most articles, they were used simultaneously. Depending on the complexity of LTFU patients, some were reengaged into HIV care was by means of a simple intervention, while others needed other more specialized services, like the referral to drug addiction units or the support of social, mental or prevention services [ 27 – 30 , 38 , 39 , 45 , 46 ]. Although diverse professionals were involved in the tracing and contact procedures, the most common categories were counsellors/patient navigators, while nurses and social workers were less common (Table 2 ).…”

“…Tracing and confirming the patient’s status was the initial way to determine if the patient is LTFU and according to the literature reviewed this was mainly achieved through the medical records [ 23 – 28 , 30 – 36 , 39 – 42 , 45 – 50 ]. Patients were most classified as: a) patients in care (transferred to other HIV clinics, with up-coming appointments, incarcerated, moved to other cities or deceased) [ 23 – 26 , 28 , 30 , 32 , 34 , 36 , 37 , 44 ]; or b) lost to follow-up or out of any HIV care or clinical follow-up.…”

“…Phone calls were used to contact the patient in almost all reviewed articles [ 23 – 38 , 40 – 43 , 46 , 48 – 50 ], with some studies specifying the number of calls made (for instance, a maximum of three calls) and the use of predesigned, tested scripts [ 25 , 30 , 33 , 36 ]. When phone calls were not successful, other contact methods were reported, including mailing notifications (email or postal) to the last known address [ 23 – 26 , 28 , 31 , 34 , 35 , 40 , 41 , 43 , 48 , 49 ], home visits [ 23 – 26 , 28 , 31 – 33 , 48 ], searching for the patient in other public or external databases [ 25 – 28 , 32 , 33 , 41 , 45 , 47 – 49 ] and contacting a close relative or their emergency contact [ 24 , 25 , 30 ].…”

“…In all interventions, professionals offered different procedures in order to reengage LTFU patients, such as identifying possible barriers/reasons for missed appointments and offering alternative solutions to facilitate reengagement and overcome those barriers [ 25 , 26 , 28 , 30 , 32 , 33 , 36 , 39 , 41 , 42 ], rescheduling appointments [ 25 , 26 , 31 – 34 , 42 , 45 ] and giving further information on medication and alternatives to access treatment [ 25 , 27 , 29 , 30 , 38 , 45 , 46 ]. Other important strategy found were building report with the patient and enhancing patient empowerment [ 26 , 29 , 40 , 41 ] by promoting the patient-centred care and setting goals for both patients and clinicians [ 27 , 29 , 31 , 38 ] (Table 3 ).…”