Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA.
Clin Infect Dis. 2012 Oct;55(8):1124-34. doi: 10.1093/cid/cis623. Epub 2012 Jul 24.
Retention in care for human immunodeficiency virus (HIV)-infected patients is a National HIV/AIDS Strategy priority. We hypothesized that retention could be improved with coordinated messages to encourage patients' clinic attendance. We report here the results of the first phase of the Centers for Disease Control and Prevention/Health Resources and Services Administration Retention in Care project.
Six HIV-specialty clinics participated in a cross-sectionally sampled pretest-posttest evaluation of brochures, posters, and messages that conveyed the importance of regular clinic attendance. 10,018 patients in 2008-2009 (preintervention period) and 11,039 patients in 2009-2010 (intervention period) were followed up for clinic attendance. Outcome variables were the percentage of patients who kept 2 consecutive primary care visits and the mean proportion of all primary care visits kept. Stratification variables were: new, reengaging, and active patients, HIV RNA viral load, CD4 cell count, age, sex, race or ethnicity, risk group, number of scheduled visits, and clinic site. Data were analyzed by multivariable log-binomial and linear models using generalized estimation equation methods.
Clinic attendance for primary care was significantly higher in the intervention versus preintervention year. Overall relative improvement was 7.0% for keeping 2 consecutive visits and 3.0% for the mean proportion of all visits kept (P < .0001). Larger relative improvement for both outcomes was observed for new or reengaging patients, young patients and patients with elevated viral loads. Improved attendance among the new or reengaging patients was consistent across the 6 clinics, and less consistent across clinics for active patients.
Targeted messages on staying in care, which were delivered at minimal effort and cost, improved clinic attendance, especially for new or reengaging patients, young patients, and those with elevated viral loads.
艾滋病毒感染者的治疗保留率是国家艾滋病毒/艾滋病战略的一个优先事项。我们假设通过协调一致的信息鼓励患者就诊，可以提高保留率。在此，我们报告疾病预防控制中心/卫生资源和服务管理局保留治疗项目的第一阶段的结果。
六个艾滋病毒专科诊所参与了一项横断面预-后测试评估，评估小册子、海报和信息传达定期就诊重要性的效果。2008-2009 年（干预前）有 10018 名患者和 2009-2010 年（干预后）有 11039 名患者接受了门诊随访。观察指标为连续两次接受初级保健就诊的患者比例和所有初级保健就诊中保持就诊的比例平均值。分层变量为：新患者、重新参与患者和活跃患者、HIV RNA 病毒载量、CD4 细胞计数、年龄、性别、种族或民族、风险群体、预约就诊次数和诊所地点。采用广义估计方程方法，使用多变量对数二项式和线性模型进行数据分析。
与干预前一年相比，干预后初级保健就诊率显著提高。保持连续两次就诊的总体相对改善为 7.0%，保持所有就诊比例的平均相对改善为 3.0%（均 P <.0001）。新患者或重新参与患者、年轻患者和病毒载量升高患者的这两个结果的相对改善更大。新患者或重新参与患者的就诊率提高在 6 个诊所中是一致的，而在活跃患者中，诊所间的一致性较差。
在努力和成本最小化的情况下，针对保持治疗的目标信息提高了就诊率，特别是对新患者或重新参与患者、年轻患者和病毒载量升高患者。
