Disease intervention specialists can bring people living with HIV back into the clinic after they have dropped out of care, but additional efforts are needed to keep them coming back, according to results from a study in Connecticut.
About This Study
"Using Data-to-Care Strategies to Optimize the HIV Care Continuum in Connecticut: Results from a Randomized Controlled Trial" was published online on Feb. 7, 2024, in Journal of Acquired Immune Deficiency Syndromes. The lead author is Eteri Machavariani, M.D., M.P.H., of the Department of Internal Medicine in the Section of Infectious Disease, HIV/AIDS Program at Yale University School of Medicine in New Haven, Connecticut.
Key Research Findings
The study randomized 655 people living with HIV who had dropped out of care in Connecticut to a data-to-care intervention strategy (n=333) and compared that to the standard of care (n=322). The study participants, recruited from 2016-2018, were 62% male and 38% female. Participants were identified by reconciling HIV surveillance data with clinic records.
The study, funded by the U.S. Centers for Disease Control and Prevention, looked at reengagement in care at 90 days and retention in care with viral suppression, at 12 months.
In the data-to-care intervention arm, government-employed disease intervention specialists tried to find missing clients and get them back into care. Once the person re-engaged in care, the disease intervention specialist provided no further services. Standard of care varied by 23 clinics, but did not involve separate outreach workers.
Ninety days after randomization, 51% of participants in the intervention arm and 42% of participants in the control arm were re-engaged in care (defined as having a laboratory report during that period). Independent predictors of re-engagement included the intervention specialist outreach, age >40 years, and people with perinatal exposure risk.
By 12 months, 53% of participants in the intervention arm and 52% of participants in the control arm remained in care (defined as two laboratory reports >90 days apart).
Viral suppression rates at 12 months were 68% of participants in the intervention arm vs. 62% of participants in the control arm. In either arm, care re-engagement within 90 days increased the chances of retention at 12 months, which in turn made viral suppression more likely.
Discussion Highlights and Implications for Practice
Reported limitations included the issue of clinics identifying out-of-care patients and potentially improving outreach as a result, perhaps enhancing the standard of care. In addition, the authors said that the strategies used to reach out-of-care people in the various HIV clinics were not examined, and may explain some differences in outcomes. Using newly-developed techniques for outreach and using a shorter time window for engagement in the intervention group were also noted.
While more clients in the intervention group were re-engaged quickly than those in the control group, 12-months retention differed little between the arms. However, the researchers emphasized that that getting people with HIV re-engaged quickly lead to better outcomes longer-term—a higher likelihood of retention in care and viral suppression at 12 months.
To keep people in care long-term, additional strategies such as mobile vans, community support centers, or telehealth need to be researched and implemented, the authors said. In addition, they suggested that adding pharmacy, social service, and other records during data reconciliation may improve the categorization and location of truly out-of-care people living with HIV.