Use of an Outreach Coordinator to Reengage and Retain Patients at Risk of Falling Out of HIV Care, Does the Amount of Time Matter?

Abstract

Retention in care remains a major problem for people living with HIV and it is well known that retention in high quality HIV care improves clinical outcomes. This project used an outreach coordinator to perform phone and letter interventions to improve retention in patients at risk of falling out of care. Sixty-one (5%) patients were at risk in 2015 and received an intervention by the outreach coordinator. Fifty (82%) had a visit and 22 (36%) met the HRSA definition of retention. The mean time per patient was 59 min; therefore, it took 2.7 h to achieve each retained patient or 1.2 h for each patient with a visit. By calculation, minutes over 75 appeared to be the point of diminishing returns. Cost analysis resulted in a cost of less than $100 per patient.

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

“…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. Three main types of interventions were then described: a) those that consisted solely on phone calls, letters/mails, text messages or home visits [ 23 – 25 , 30 , 43 ], b) others that started by establishing initial contact and were later complemented by a face-to-face intervention in the HIV clinic guided by a trained professional [ 26 , 28 , 29 , 32 – 35 , 41 , 43 ] and c) a few opportunistic interventions addressed to out-of-care patients who were found in other medical units or contacted their health providers for different reasons not pertaining to HIV care [ 38 , 40 ].…”

“…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 ].…”

“…Different variables are seen to be associated with successful interventions. In the United States, patients with Asiatic background were more likely to be reengaged than blacks [ 30 , 33 , 43 ]. Age and gender are also associated with successful reengagement and retention, with some studies showing that younger patients are less reengaged than those over 40 years of age [ 23 , 25 , 33 ] and males reengaged less than women [ 24 , 44 ].…”

HIV Care Coordination promotes care re-engagement and viral suppression among people who have been out of HIV medical care: an observational effectiveness study using a surveillance-based contemporaneous comparison group

“…According to the Centers for Disease Control and Prevention (CDC) Compendium of Evidence-Based Interventions and Best Practices for HIV Prevention, multiple interventions show strong evidence of efficacy for initial linkage to care, subsequent retention in care and VS, but none have generated strong evidence of efficacy for care re-engagement (CR) following a lapse [4]. Promising CR approaches include case management, patient navigation, outreach and uses of populationbased data or routine testing to identify candidates for re-linkage [5][6][7][8][9][10][11][12][13][14]. However, studies to date have lacked contemporaneous, comparable out-of-care control groups [7][8][9][10][11][12][13][14][15] or have focused on linkage and retention rather than quantifying CR [5][6][7].…”

“…Promising CR approaches include case management, patient navigation, outreach and uses of populationbased data or routine testing to identify candidates for re-linkage [5][6][7][8][9][10][11][12][13][14]. However, studies to date have lacked contemporaneous, comparable out-of-care control groups [7][8][9][10][11][12][13][14][15] or have focused on linkage and retention rather than quantifying CR [5][6][7].…”