Use of an Outreach Coordinator to Reengage and Retain Patients with HIV in Care

Abstract

It is well established that retention in high-quality care and regular visits with an HIV/AIDS provider improve outcomes for people living with HIV/AIDS (PLWHA). However, nationally and regionally in South Carolina, retention rates remain low. We piloted an outreach program focused on characterizing out of care (OOC) patients to identify PLWHA who were lost to care and attempt reengagement through phone call, letter, and home visit interventions. Primary outcomes were reengagement, defined as attendance to a clinic appointment, and retention in care, defined by the Health Resources and Services Administration (HRSA) definition (two visits at least 90 days apart in 2015). There were 1242 adult clinic patients in 2014. A total of 233 patients were included in the OOC cohort, according to the inclusion criteria. Of these 233, the outreach coordinator found that a majority of patients, 119 (51%), were lost to care. Reengagement was seen in 52 (44%) patients lost to care, and among those who reengaged, 26 (50%) were retained in care in 2015. This report represents one of few interventions that target reengagement for patients who are lost to care. The use of an outreach coordinator was successful in reengaging and retaining patients in care. It represents an uncomplicated intervention, functional within the current clinic design and available funding structure of the Ryan White grant. Poor engagement and retention in care continue to be significant problems among PLWHA with resultant poor clinical outcomes. Continued focus on new interventions to improve retention in care is necessary to improve clinical outcomes.

Improving HIV Care Engagement in the South from the Patient and Provider Perspective: The Role of Stigma, Social Support, and Shared Decision-Making

“…Outreach coordinators have also been used successfully to re-engage people who are lost to care through letters, phone calls, and home visits. 47 Use of a multi-modality App-based intervention, PositiveLinks, was associated with increased virologic suppression and reduced perceived stigma. 48,49 This type of intervention, which gives appointment reminders, provides an additional line of communication between patient and provider, and includes an anonymous virtual support group for peer to peer support, may be particularly well received in our context as it incorporates many participant suggestions into one intervention.…”

Retention and adherence

“…within a shorter time frame and improved adherence for the intervention group [42]. Strategies to improve re-engagement after loss to follow-up (LTFU) from adult care through outreach coordinators, peer facilitators, and LTFU protocols have encouraging results but lack age-disaggregated data for AYA [43,44]. The use of mobile phone technology to improve adherence in adolescents has shown promise in terms of feasibility and acceptability, although more modest efficacy, and is being evaluated further in the US "weCare" program [45][46][47].…”

The impact of PEPFAR transition on HIV service delivery at health facilities in Uganda

“…HIV outreach is an important service linking facilities and communities. This study did not define outreach precisely, but it is likely to include bringing HIV testing services to populations that do not regularly seek care at facilities, particularly men and adolescents [37], as well as providing adherence counseling, defaulter tracing, and other efforts that have been demonstrated as successful in improving retention in care [38, 39].…”