Successful expanded clinic network collaboration and patient tracing for retention in HIV care

AIDS Research and Therapy

Research

Christopher Sherman¹  Amanda Wade²  Christine Roder²  Judy Lamb³  Andrew Mahony⁴  Ban-Kiem Tee⁵  Lyn-Li Lim⁶  Fran Bramwell⁷  Alan Street⁸  Jeni Mitchell⁸  Nicholas Medland⁹  Sheranne Dobinson⁹  Ian Woolley^1,10  Jessica O’Bryan^1,10  Craig Aboltins^1,11  Siaw Hui Wong^1,11  William Mitchell^1,12  Beng Eu^1,13  Helen Lau^1,14  Maxine Giourouki^1,15  James H McMahon^1,16  Mellissa Bryant^1,17  Shivani Bhatt^1,17  Jennifer F Hoy^1,17  Adrian Tramontana^1,18 

[1] Armadale Family Practice, Melbourne, Australia;Barwon Health, Geelong, Australia;Bendigo Health, Bendigo, Australia;Bendigo Health, Bendigo, Australia;Austin Health, Melbourne, Australia;Centre Clinic, Melbourne, Australia;Access Health, Melbourne, Australia;Eastern Health, Melbourne, Australia;Health Works Co Health, Melbourne, Australia;Melbourne Health, Melbourne, Australia;Melbourne Sexual Health Centre, Melbourne, Australia;Monash Health, Melbourne, Australia;Northern Health, Melbourne, Australia;Northside Clinic, Melbourne, Australia;Prahran Market Clinic, Melbourne, Australia;Prahran Market Clinic, Melbourne, Australia;Centre Clinic, Melbourne, Australia;St Vincent’s Hospital,, Melbourne, Australia;The Alfred Hospital, Melbourne, Australia;Monash Health, Melbourne, Australia;Monash University, Melbourne, Australia;The Alfred Hospital, Melbourne, Australia;Monash University, Melbourne, Australia;Western Health, Melbourne, Australia;

关键词: HIV;    Retention in care;    Lost to follow-up;    Cascade of care;    Intervention study;    Clinical outcomes;   

DOI  :  10.1186/s12981-022-00476-x

 received in 2022-08-04, accepted in 2022-10-26,  发布年份 2022

来源: Springer

【 摘 要 】

BackgroundThere are more than 7,800 people living with human immunodeficiency virus (HIV) in Victoria, Australia. Crucial in maximising the individual and population level benefits from antiretroviral therapy (ART) is understanding how to achieve patient retention in care and the factors that drive it. This study was an expansion of a 2015 assessment of HIV-care retention in Victoria, which sought out to determine whether the inclusion of a broader range of HIV-healthcare sites would yield more accurate estimates of retention in HIV-care. We aimed to improve our understanding of HIV-care retention in Victoria, Australia, identify people living with HIV (PLHIV) with unknown outcomes, and attempt to re-engage PLHIV in care.MethodsA network of 15 HIV-care sites was established in Victoria, Australia across diverse care settings which ranged from low-caseload rural sites to high-caseload metropolitan GP clinics and hospitals. Individuals who had an HIV viral load (VL) performed in both calendar years of 2016 and 2017 were classified as retained in care. Individuals with a VL test in 2016 but not in 2017 were considered to potentially have unknown outcomes as they may have been receiving care elsewhere, have disengaged from care or died. For this group, an intervention of cross-referencing partially de-identified data between healthcare sites, and contact tracing individuals who still had unknown outcomes was performed.ResultsFor 5223 individuals considered to be retained in care across 15 healthcare sites in the study period, 49 had unconfirmed transfers of care to an alternative provider and 79 had unknown outcomes. After the intervention, the number of unconfirmed care transfers was reduced to 17 and unknown outcomes reduced to 51. These changes were largely attributed to people being reclassified as confirmed transfers of care. Retention in care estimates that did not include the patient outcome of confirmed transfer of care ranged from 76.2 to 95.8% and did not alter with the intervention. However, retention in care estimates which considered confirmed transfers and those that re-entered care at a new site as retained in care significantly increased across five of the sites with estimates ranging from 80.9 to 98.3% pre-intervention to 83.3–100% post-intervention. Individuals whose outcomes remained unknown post-intervention were more often men who have sex with men (MSM) when compared to other categories (person who injects drugs (PWID), combined PWID/MSM, men who identify as heterosexual or unknown) (74.5% vs. 53.5%, [p = 0.06]) and receiving ART at their last HIV-care visit (84.3% vs. 67.8% [p = 0.09]).ConclusionThis study confirmed high retention in HIV-care and low numbers of people disengaged from HIV-care in Victoria. This was demonstrated across a larger number of sites with varying models of care than a prior assessment in 2015. These data align with national and state targets aiming for 95% of PLHIV retained in HIV-care.

【 授权许可】

CC BY   
© The Author(s) 2022