Gardner Lytt I, Giordano Thomas P, Marks Gary, Wilson Tracey E, Craw Jason A, Drainoni Mari-Lynn, Keruly Jeanne C, Rodriguez Allan E, Malitz Faye, Moore Richard D, Bradley-Springer Lucy A, Holman Susan, Rose Charles E, Girde Sonali, Sullivan Meg, Metsch Lisa R, Saag Michael, Mugavero Michael J
Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia.
Department of Medicine, Baylor College of Medicine, and the Center for Innovations in Quality, Effectiveness and Safety, Michael. E. DeBakey Veterans Affairs Medical Center, Houston, Texas.
Clin Infect Dis. 2014 Sep 1;59(5):725-34. doi: 10.1093/cid/ciu357. Epub 2014 May 15.
The aim of the study was to determine whether enhanced personal contact with human immunodeficiency virus (HIV)-infected patients across time improves retention in care compared with existing standard of care (SOC) practices, and whether brief skills training improves retention beyond enhanced contact.
The study, conducted at 6 HIV clinics in the United States, included 1838 patients with a recent history of inconsistent clinic attendance, and new patients. Each clinic randomized participants to 1 of 3 arms and continued to provide SOC practices to all enrollees: enhanced contact with interventionist (EC) (brief face-to-face meeting upon returning for care visit, interim visit call, appointment reminder calls, missed visit call); EC + skills (organization, problem solving, and communication skills); or SOC only. The intervention was delivered by project staff for 12 months following randomization. The outcomes during that 12-month period were (1) percentage of participants attending at least 1 primary care visit in 3 consecutive 4-month intervals (visit constancy), and (2) proportion of kept/scheduled primary care visits (visit adherence).
Log-binomial risk ratios comparing intervention arms against the SOC arm demonstrated better outcomes in both the EC and EC + skills arms (visit constancy: risk ratio [RR], 1.22 [95% confidence interval {CI}, 1.09-1.36] and 1.22 [95% CI, 1.09-1.36], respectively; visit adherence: RR, 1.08 [95% CI, 1.05-1.11] and 1.06 [95% CI, 1.02-1.09], respectively; all Ps < .01). Intervention effects were observed in numerous patient subgroups, although they were lower in patients reporting unmet needs or illicit drug use.
Enhanced contact with patients improved retention in HIV primary care compared with existing SOC practices. A brief patient skill-building component did not improve retention further. Additional intervention elements may be needed for patients reporting illicit drug use or who have unmet needs.
CDCHRSA9272007.
本研究的目的是确定与现有标准护理（SOC）措施相比，随着时间推移加强与人类免疫缺陷病毒（HIV）感染患者的个人接触是否能提高护理留存率，以及简短的技能培训是否能在加强接触的基础上进一步提高留存率。
该研究在美国的6家HIV诊所进行，纳入了1838例近期就诊情况不稳定的患者以及新患者。每家诊所将参与者随机分为3组中的1组，并继续为所有入组者提供SOC措施：与干预者加强接触（EC）（复诊时进行简短面对面会面、中期访视电话、预约提醒电话、漏访电话）；EC+技能（组织、解决问题和沟通技能）；或仅SOC。随机分组后，项目工作人员进行为期12个月的干预。在这12个月期间的结果包括：（1）连续3个4个月间隔内至少进行1次初级保健访视的参与者百分比（就诊稳定性），以及（2）已进行的/已安排的初级保健访视比例（就诊依从性）。
将干预组与SOC组进行比较的对数二项风险比显示，EC组和EC+技能组的结果均更好（就诊稳定性：风险比[RR]分别为1.22[95%置信区间{CI}，1.09 - 1.36]和1.22[95%CI，1.09 - 1.36]；就诊依从性：RR分别为1.08[95%CI，1.05 - 1.11]和1.06[95%CI，1.02 - 1.09]；所有P值<0.01）。在众多患者亚组中均观察到干预效果，尽管在报告有未满足需求或使用非法药物的患者中效果较低。
与现有SOC措施相比，加强与患者的接触可提高HIV初级保健的留存率。简短的患者技能培养部分并未进一步提高留存率。对于报告使用非法药物或有未满足需求的患者，可能需要额外的干预措施。
CDCHRSA9272007。
