Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2020 Feb 21:6:29.
doi: 10.1186/s40814-020-0559-6. eCollection 2020.

A type II implementation-effectiveness hybrid quasi-experimental pilot study of a clinical intervention to re-engage people living with HIV into care, 'Lost & Found': an implementation science protocol

Joseph Cox #  1   2   3   4 , Blake Linthwaite #  1   2 , Kim Engler  2 , David Lessard  2 , Bertrand Lebouché  1   2   5 , Nadine Kronfli  1   2   3   4
Affiliations

A type II implementation-effectiveness hybrid quasi-experimental pilot study of a clinical intervention to re-engage people living with HIV into care, 'Lost & Found': an implementation science protocol

Joseph Cox et al. Pilot Feasibility Stud. .

Abstract

Background: At the McGill University Health Centre (MUHC), 10% of patients living with HIV do not return for care annually. Currently, no formal system exists to re-engage out-of-care (OOC) patients. Lost & Found, developed using an implementation science approach, is an intervention to re-engage OOC patients. It is based on existing evidence-based interventions and will be adapted for use by nurses at the MUHC. The aims of this study are to simultaneously assess both implementation and effectiveness of Lost & Found in order to determine the viability of a future multisite stepped-wedge cluster randomised trial.

Methods: Lost & Found consists of two core elements: identifying and contacting OOC patients. Based on formative work involving MUHC nurses, and the use of a combined implementation framework (enhanced Replicating Effective Programs, Tailored Implementation for Chronic Diseases, and Proctor et al.'s implementation outcomes), we will adapt the intervention to our clinic. Adaptations include the creation of an OOC risk prediction tool, an automated real-time OOC list, and prioritization of high-risk OOC patients for re-engagement. Delivery and ongoing adaptation of the intervention will follow a three-pronged implementation strategy consisting of (1) promoting adaptability; (2) planning, engaging, executing, evaluating, and reflecting cycles; and (3) internal facilitation. This 15-month quasi-experimental pilot study adopts a type II implementation-effectiveness hybrid design. To evaluate implementation, a convergent parallel mixed-methods approach will guide the mixing of qualitative and quantitative data at time points throughout the study. In addition, descriptive and pre-post analyses, for each of the implementation and sustainability phases, will inform evaluations of the cumulative effectiveness and sustainability of the Lost & Found intervention.

Discussion: This study will provide preliminary evidence for (1) the utility of our chosen implementation strategies and (2) the effectiveness of the intervention. Ultimately, this information may be used to inform future re-engagement efforts using implementation science in other HIV care centres. In addition, the procedures and measurement tools developed for this study will be foundational to the development of a multi-site, randomised stepped wedge study that would provide more robust evidence in support of the Lost & Found intervention.

Keywords: HIV; Implementation science; Implementation strategies; Lost to follow-up; Nursing; Out-of-care; Re-engagement.

PubMed Disclaimer

Conflict of interest statement

Competing interestsJC has received consulting fees from ViiV Healthcare, Merck, and Gilead; research funding from ViiV Healthcare, Merck, and Gilead; and payment for lectures from Gilead. BL2 has received consulting fees from ViiV Healthcare and Gilead; research funding from Merck, Gilead, and Abbvie; and payment for lectures from Merck and Gilead. NK has received consulting fees from ViiV Healthcare, Merck, and Gilead; research funding from ViiV Healthcare and Gilead; and payment for lectures from Gilead. All other authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
OOC risk prediction tool (OOC-RPT)
Fig. 2
Fig. 2
Implementation strategies by eREP implementation phase
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

References

    1. UNAIDS . Ending AIDS: Progress Towards the 90-90-90 Targets. 2017.
    1. Government of Canada . Summary: Measuring Canada’s progress on the 90-90-90 HIV targets. 2016.
    1. Wohl AR, Dierst-Davies R, Victoroff A, James S, Bendetson J, Bailey J, et al. Implementation and Operational Research: The Navigation Program: An Intervention to Reengage Lost Patients at 7 HIV Clinics in Los Angeles County, 2012–2014. J Acquir Immune Defic Syndr. 2016;71(2):44–50. doi: 10.1097/QAI.0000000000000871. - DOI - PubMed
    1. Skarbinski J, Rosenberg E, Paz-Bailey G, Hall HI, Rose CE, Viall AH, et al. Human immunodeficiency virus transmission at each step of the care continuum in the United States. JAMA Intern Med. 2015;175(4):588–596. doi: 10.1001/jamainternmed.2014.8180. - DOI - PubMed
    1. Gardner EM. Editorial Commentary: Improving Retention in HIV Care: A Cost-effective Strategy to Turn the Tide on HIV and AIDS in the United States. Clin Infect Dis. 2016;62(2):230–232. doi: 10.1093/cid/civ804. - DOI - PubMed

LinkOut - more resources