Re-Engagement into HIV Care: A Systematic Review

Blanco, Natalia; Lavoie, Marie‐Claude; Koech, Emily; Riedel, David J.; Ng’eno, Caroline; Adebajo, Sylvia; Ludeman, Emilie; Stafford, Kristen A.

doi:10.1007/s10461-021-03365-y

Cited by 8 publications

(8 citation statements)

References 28 publications

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“…The most recent meta-analyses of outcomes for persons with HIV (PLH) in the United States who are out-of-care [1] indicate both the progress made and the challenges that remain in designing and broadly implementing interventions for PLH. In contrast to two earlier review articles on this topic [2,3], this meta-analysis found significant benefits of five different HIV-related interventions: patient navigation, appointment alerts; transportation and appointment coordination; social support, and data-to-care (i.e. using a surveillance system to inform providers when a PLH has dropped out-of-care).…”

contrasting

confidence: 82%

Strategies to improve HIV care outcomes for people with HIV who are out of care: the need for well designed health systems

Rotheram-Borus

2022

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contrasting

confidence: 82%

Strategies to improve HIV care outcomes for people with HIV who are out of care: the need for well designed health systems

Rotheram-Borus

2022

Aids

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“…Of the studies that examined retention in HIV care, outcome measures were highly diverse and characterized by four categories: changes in clinic visits, laboratory tests, ART use, and HIV viral load suppression. Therefore, there is a need for consistent health care utilization metrics and definitions across interventions as part of the larger goal to end the HIV epidemic [ 81 , 82 ].…”

Section: Discussionmentioning

confidence: 99%

Feasibility and Acceptability of the Adherence Connection Counseling, Education, and Support (ACCESS) Proof of Concept: A Peer-Led, Mobile Health (mHealth) Cognitive Behavioral Antiretroviral Therapy (ART) Adherence Intervention for HIV-Infected (HIV+) Adolescents and Young Adults (AYA)

et al. 2022

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Effective antiretroviral therapy (ART) adherence strategies for HIV+ adolescents and young adults (AYA) are needed to prevent HIV-related morbidity, mortality, and onward transmission. In the Adherence Connection for Counseling, Education, and Support (ACCESS) pilot, an exploratory sequential mixed-methods design was used to develop and test a peer-led, mobile health (mHealth) cognitive behavioral ART adherence intervention. HIV+ AYA (ages 16–29 years) with unsuppressed plasma HIV RNA (HIV viral load) were eligible for this five-session intervention directed to improving ART adherence and HIV viral load. A total of 78 peer-led remote videoconferencing sessions (via WebEx) were delivered to 16 participants. High completion rates (97.5%) and client satisfaction scores (mean = 29.13 of 32; SD = 2.45) were observed. Self-reported ART adherence improved (32% increase in doses taken; 95th CI 11.2–53.3) with an annualized average rate of 47.5% (0.28 log 10 ) reduction in HIV viral load. We established proof of concept for the ACCESS peer-led, mHealth cognitive behavioral ART adherence intervention, with promising adherence and virologic outcome data.

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“…Eligibility criteria were intervention studies conducted in the U.S., included comparisons between groups or prepost, published between 2000 and 2020, tested interventions for helping care engagement of OOC PWH, and reported one of the following outcomes: reengagement in care, retention in care, and viral suppression. As noted in the previous qualitative systematic reviews [23,24], there was substantial heterogeneity in definitions of outcomes and OOC populations in the literature. For comprehensiveness, we accepted author definitions.…”

Section: Inclusion Criteriamentioning

confidence: 95%

“…Because RCTs may be impractical to implement in real world settings, alternate innovative methods such as constructing a comparison group from surveillance data or using a stepped-wedge design are worth considering [16,45]. Working toward a common definition of OOC and standardized HIV care outcome measurements [23,24,71] and thresholds for clinical significance that are meaningful from a public health perspective would further facilitate evaluation and research synthesis of the re-engagement literature. Similarly, establishing a standard for re-engagement that parallels the national indicator for linkage to care for persons who are newly diagnosed may help with evaluating re-engagement programs.…”

Section: Future Research Directionsmentioning

confidence: 99%

“…An evaluation of intervention strategies is needed for identifying best practices for re-engagement in care. Previous qualitative systematic reviews have noted few studies improved re-engagement in care among PWH [23,24]. We expanded the scope of these previous qualitative reviews by including the most recent literature (2000-2020) and conducting meta-analyses to assess the effectiveness of five common intervention strategies: patient navigation, appointment help/alerts, psychosocial support, transportation/appointment accompaniment, and data-to-care on HIV care outcomes (i.e.…”

Section: Introductionmentioning

confidence: 99%

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Strategies to improve HIV care outcomes for people with HIV who are out of care

Higa¹,

Crepaz²,

Mullins³

et al. 2022

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Objective: The aim of this study was to evaluate the effectiveness of five intervention strategies: patient navigation, appointment help/alerts, psychosocial support, transportation/appointment accompaniment, and data-to-care on HIV care outcomes among persons with HIV (PWH) who are out of care (OOC).Design: A systematic review with meta-analysis.Methods: We searched CDC's Prevention Research Synthesis (PRS) Project's cumulative HIV database to identify intervention studies conducted in the U.S., published between 2000 and 2020 that included comparisons between groups or prepost, and reported at least one relevant outcome (i.e. re-engagement or retention in HIV care, and viral suppression). Effect sizes were meta-analyzed using random-effect models to assess intervention effectiveness.Results: Thirty-nine studies reporting on 42 unique interventions met the inclusion criteria. Overall, intervention strategies are effective in improving re-engagement in care [odds ratio (OR) ¼ 1.79;95% confidence interval (95% CI): 1.36-2.36, k ¼ 14], retention in care (OR ¼ 2.01; 95% CI: 1.64-2.64, k ¼ 22), and viral suppression (OR ¼ 2.50;95% CI: 1.87-3.34, k ¼ 27). Patient navigation, appointment help/alerts, psychosocial support, and transportation/appointment accompaniment improved all three HIV care outcomes. Data-to-care improved re-engagement and retention but had insufficient evidence for viral suppression. Conclusion:Several strategies are effective for improving HIV care outcomes among PWH who are OOC. More work is still needed for consistent definitions of OOC and HIV care outcomes, better reporting of intervention and cost data, and identifying how best to implement and scale-up effective strategies to engage and retain OOC PWH in care and reach the ending the HIV epidemic goals.

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Re-Engagement into HIV Care: A Systematic Review

Cited by 8 publications

References 28 publications

Strategies to improve HIV care outcomes for people with HIV who are out of care: the need for well designed health systems

Strategies to improve HIV care outcomes for people with HIV who are out of care: the need for well designed health systems

Feasibility and Acceptability of the Adherence Connection Counseling, Education, and Support (ACCESS) Proof of Concept: A Peer-Led, Mobile Health (mHealth) Cognitive Behavioral Antiretroviral Therapy (ART) Adherence Intervention for HIV-Infected (HIV+) Adolescents and Young Adults (AYA)

Strategies to improve HIV care outcomes for people with HIV who are out of care

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