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
Randomized Controlled Trial
. 2022 Nov 23;23(1):297.
doi: 10.1186/s12875-022-01909-2.

HIV retention in care: results and lessons learned from the Positive Pathways Implementation Trial

Michael B Wohlfeiler  1 , Rachel Palmieri Weber  2 , Laurence Brunet  3 , Jennifer S Fusco  3 , Christine Uranaka  1 , Quateka Cochran  1 , Monica Palma  1 , Tammeka Evans  4 , Carl Millner  1 , Gregory P Fusco  3
Affiliations
Randomized Controlled Trial

HIV retention in care: results and lessons learned from the Positive Pathways Implementation Trial

Michael B Wohlfeiler et al. BMC Prim Care. .

Abstract

Background: Sustained, routine care is vital to the health of people with HIV (PWH) and decreasing transmission of HIV. We evaluated whether the identification of PWH at-risk of falling out of care and prompts for outreach were effective in retaining PWH in care in the United States.

Methods: In this cluster randomized controlled trial, 20 AIDS Healthcare Foundation Healthcare Centers (HCCs) were randomized to the intervention (n = 10) or control (n = 10) arm; all maintained existing retention efforts. The intervention included daily automated flags in CHORUS™, a mobile app and web-based reporting solution utilizing electronic health record data, that identified PWH at-risk of falling out of care to clinic staff. Among flagged PWH, the association between the intervention and visits after a flag was assessed using logistic regression models fit with generalized estimating equations (independent correlation structure) to account for clustering. To adjust for differences between HCCs, models included geographic region, number of PWH at HCC, and proportions of PWH who self-identified as Hispanic or had the Ryan White Program as a payer.

Results: Of 15,875 PWH in care, 56% were flagged; 76% (intervention) and 75% (control) resulted in a visit, of which 76% were within 2 months of the flag. In adjusted analyses, flags had higher odds of being followed by a visit (odds ratio [OR]: 1.08, 95% confidence interval [CI]: 0.97, 1.21) or a visit within 2 months (OR: 1.07, 95% CI: 0.97, 1.17) at intervention than control HCCs. Among at-risk PWH with viral loads at baseline and study end, the proportion with < 50 copies/mL increased in both study arms, but more so at intervention (65% to 74%) than control (62% to 67%) HCCs.

Conclusion: Despite challenges of the COVID-19 pandemic, adding an intervention to existing retention efforts, and the reality that behavior change takes time, PWH flagged as at-risk of falling out of care were marginally more likely to return for care at intervention than control HCCs and a greater proportion achieved undetectability. Sustained use of the retention module in CHORUS™ has the potential to streamline retention efforts, retain more PWH in care, and ultimately decrease transmission of HIV.

Trial registration: The study was first registered at Clinical Trials.gov (NCT04147832, https://clinicaltrials.gov/show/NCT04147832 ) on 01/11/2019.

Keywords: Alerts; Clinical Decision Support System; HIV; HIV Treatment and Prevention; Re-engagement; Retention in Care.

PubMed Disclaimer

Conflict of interest statement

MBW has participated in post-conference advisory boards for the Conference on Retroviruses and Opportunistic Infections (CROI) and International AIDS Conference (IAC) and serves as a principal investigator on ViiV Healthcare clinical trials but does not receive personal compensation for this work, which goes directly to the AIDS Healthcare Foundation. MBW is also a member of the Epidemiology and Clinical Advisory Board for Epividian, Inc. RPW, LB, JSF, and GPF are employed by Epividian, Inc.; Epividian has had research funded by the AIDS Healthcare Foundation, EMD Serono, Gilead Sciences, Janssen Pharmaceutica, Merck & Co., Theratechnologies Inc., and ViiV Healthcare. CU, QC, MP, and CM have no conflicts of interest to declare. TE is employed by ViiV Healthcare and holds stocks and shares in GSK as part of their employment.

Figures

Fig. 1
Fig. 1
Alert Types and Distribution Over Follow-Up Up Among Intervention HCCs (n = 8,860 alerts) and Control HCCs (n = 6,878 alerts)
Fig. 2
Fig. 2
Adjusted Odds Ratios for the Association Between the Intervention and Visits After Flags
See this image and copyright information in PMC

References

    1. Tripathi A, Youmans E, Gibson JJ, Duffus WA. The impact of retention in early HIV medical care on viro-immunological parameters and survival: a statewide study. AIDS Res Hum Retroviruses. 2011;27(7):751–8. doi: 10.1089/aid.2010.0268. - DOI - PubMed
    1. Mugavero MJ, Davila JA, Nevin CR, Giordano TP. From Access to Engagement: measuring Retention in Outpatient HIV Clinical Care. AIDS Patient Care STDs. 2010;24(10):607–13. doi: 10.1089/apc.2010.0086. - DOI - PMC - PubMed
    1. Mugavero MJ, Westfall AO, Cole SR, Geng EH, Crane HM, Kitahata MM, Mathews WC, Napravnik S, Eron JJ, Moore RD, et al. Beyond core indicators of retention in HIV care: missed clinic visits are independently associated with all-cause mortality. Clin Infect Dis. 2014;59(10):1471–9. doi: 10.1093/cid/ciu603. - DOI - PMC - PubMed
    1. Mugavero MJ, Lin HY, Willig JH, Westfall AO, Ulett KB, Routman JS, Abroms S, Raper JL, Saag MS, Allison JJ. Missed visits and mortality among patients establishing initial outpatient HIV treatment. Clin Infect Dis. 2009;48(2):248–56. doi: 10.1086/595705. - DOI - PMC - PubMed
    1. Giordano TP, Gifford AL, White AC, Jr, Suarez-Almazor ME, Rabeneck L, Hartman C, Backus LI, Mole LA, Morgan RO. Retention in care: a challenge to survival with HIV infection. Clin Infect Dis. 2007;44(11):1493–9. doi: 10.1086/516778. - DOI - PubMed

Publication types

Associated data