Bean Madelyne C, Scott Linda, Kilby J Michael, Richey Lauren E
Division of Infectious Disease, Medical University of South Carolina , Charleston, South Carolina.
AIDS Patient Care STDS. 2017 May;31(5):222-226. doi: 10.1089/apc.2016.0318. Epub 2017 May 10.
It is well established that retention in high-quality care and regular visits with an HIV/AIDS provider improve outcomes for people living with HIV/AIDS (PLWHA). However, nationally and regionally in South Carolina, retention rates remain low. We piloted an outreach program focused on characterizing out of care (OOC) patients to identify PLWHA who were lost to care and attempt reengagement through phone call, letter, and home visit interventions. Primary outcomes were reengagement, defined as attendance to a clinic appointment, and retention in care, defined by the Health Resources and Services Administration (HRSA) definition (two visits at least 90 days apart in 2015). There were 1242 adult clinic patients in 2014. A total of 233 patients were included in the OOC cohort, according to the inclusion criteria. Of these 233, the outreach coordinator found that a majority of patients, 119 (51%), were lost to care. Reengagement was seen in 52 (44%) patients lost to care, and among those who reengaged, 26 (50%) were retained in care in 2015. This report represents one of few interventions that target reengagement for patients who are lost to care. The use of an outreach coordinator was successful in reengaging and retaining patients in care. It represents an uncomplicated intervention, functional within the current clinic design and available funding structure of the Ryan White grant. Poor engagement and retention in care continue to be significant problems among PLWHA with resultant poor clinical outcomes. Continued focus on new interventions to improve retention in care is necessary to improve clinical outcomes.
众所周知，坚持接受高质量护理并定期就诊于艾滋病毒/艾滋病服务提供者可改善艾滋病毒/艾滋病感染者（PLWHA）的治疗效果。然而，在南卡罗来纳州的全国和地区层面，留存率仍然很低。我们开展了一项外展项目，重点是对失访（OOC）患者进行特征分析，以识别失去随访的PLWHA，并尝试通过电话、信件和家访干预措施重新建立联系。主要结局指标为重新建立联系，定义为参加门诊预约，以及持续接受护理，按照卫生资源与服务管理局（HRSA）的定义（2015年至少间隔90天的两次就诊）。2014年有1242名成年门诊患者。根据纳入标准，共有233名患者被纳入失访队列。在这233名患者中，外展协调员发现大多数患者，即119名（51%）失去了随访。在119名失去随访的患者中，有52名（44%）重新建立了联系，在这些重新建立联系的患者中，有26名（50%）在2015年持续接受了护理。本报告是针对失去随访的患者重新建立联系的少数干预措施之一。使用外展协调员成功地使患者重新建立联系并持续接受护理。这是一种简单的干预措施，在当前诊所设计和瑞安·怀特基金的可用资金结构范围内发挥作用。在PLWHA中，参与度低和持续接受护理的情况仍然是重大问题，导致临床结局不佳。持续关注新的干预措施以提高护理留存率对于改善临床结局是必要的。
