Disease Intervention Specialist Field Experience in Re-engaging Out-of-Care People with HIV in Project CoRECT: A Mixed Methods Study

Abstract

The HIV care continuum is a framework that describes gaps in care engagement for people with HIV (PWH) who know their HIV status, are on antiretroviral therapy, and are virally suppressed. Despite the United Nations' 95 - 95 - 95 targets, significant gaps remain in the United States, driven by PWH who are not engaged in care. To evaluate a Data-to-Care strategy to re-engage PWH who recently fell out of care, the Centers for Disease Control and Prevention funded a randomized, controlled trial called the Cooperative Re-Engagement Controlled Trial (CoRECT) was conducted in Connecticut, Massachusetts, and Pennsylvania between 2014 and 2018. Three Disease Intervention Specialists (DIS) were trained to provide a public health intervention that adapted the Anti-Retroviral Treatment and Access to Services (ARTAS) model for re-engaging PWH in care. In this secondary analysis, we examined the implementation processes and field experiences of DIS in Connecticut using an explanatory sequential mixed methods design. Data sources included DIS field notes, an internal database, and in-depth interviews with two DIS. We found that the fidelity to the adapted ARTAS (ARTAS+) varied considerably, barriers to care assessments were completed consistently (95%), and structured interactive sessions were completed less frequently (35%). Qualitative interviews with DIS highlighted the importance of flexibility and rapport-building in re-engagement efforts. Re-engagement efforts were negatively impacted by psychiatric and substance use disorders and homelessness, while patient-reported barriers included time mismanagement, inconvenient clinic operational hours, or not perceiving themselves as sick. The study provides a roadmap for future Data-to-Care implementation efforts and underscores the importance of patient-centered approaches for re-engaging PWH in care. TRIAL REGISTRATION: https://www.clinicaltrials.gov/ with an identifier NCT02693145.

Keywords: Data-to-care; Disease Intervention Specialists; HIV; HIV Treatment as Prevention; Implementation Science.