Research Institute of the McGill University Health Centre (RI-MUHC).
Division of Infectious Diseases and Chronic Viral Illness Service, Department of Medicine.
AIDS. 2022 Mar 15;36(4):551-560. doi: 10.1097/QAD.0000000000003147.
Negative health outcomes associated with being out of HIV care (OOC) warrant reengagement strategies. We aimed to assess effectiveness of Lost & Found, a clinic-based intervention to identify and reengage OOC patients.
Developed and delivered using implementation science, Lost & Found consists of two core elements: identification, operationalized through nurse validation of a real-time list of possible OOC patients; and contact, via nurse-led phone calls. It was implemented over a 12-month period (2018-2019) at the Chronic Viral Illness Service, McGill University Health Centre (CVIS-MUHC) during a type-II implementation-effectiveness hybrid pilot study. Descriptive outcomes of interest were identification as possibly OOC, OOC confirmation, contact, and successful reengagement. We present results from a pre-post analysis comparing overall reengagement to the year prior, using robust Poisson regression controlled for sex, age, and Canadian birth. Time to reengagement is reported using a Cox proportional hazards model.
Over half (56%; 1312 of 2354) of CVIS-MUHC patients were identified as possibly OOC. Among these, 44% (n = 578) were followed elsewhere, 19% (n = 249) engaged in care, 3% (n = 33) deceased, 2% (n = 29) otherwise not followed, and 32% (n = 423) OOC. Of OOC patients contacted (85%; 359/423), 250 (70%) reengaged and 40 (11%) had upcoming appointments; the remainder were unreachable, declined care, or missed given appointments. Pre-post results indicate people who received Lost & Found were 1.18 [95% confidence interval (CI) 1.02-1.36] times more likely to reengage, and reengaged a median 55 days (95% CI 14-98) sooner.
Lost & Found may be a viable clinic-based reengagement intervention for OOC patients. More robust evaluations are needed.
与 HIV 护理脱节（OOC）相关的不良健康后果需要重新参与策略。我们旨在评估“失落与发现”（Lost & Found）的有效性，这是一种基于诊所的干预措施，旨在识别和重新参与 OOC 患者。
采用实施科学方法开发和实施的“失落与发现”包括两个核心要素：识别，通过护士验证实时可能的 OOC 患者名单来实现；以及联系，通过护士主导的电话联系。它在麦吉尔大学健康中心（McGill University Health Centre，CVIS-MUHC）的慢性病毒感染服务（Chronic Viral Illness Service，CVIS-MUHC）实施了 12 个月（2018-2019 年），在此期间进行了 II 型实施效果混合试点研究。感兴趣的描述性结果包括被识别为可能的 OOC、OOC 确认、联系和成功重新参与。我们使用稳健泊松回归控制性别、年龄和加拿大出生情况，对整体重新参与与前一年进行了前后分析比较。使用 Cox 比例风险模型报告重新参与的时间。
CVIS-MUHC 的一半以上（56%，1312/2354）的患者被确定为可能的 OOC。在这些患者中，44%（n=578）在其他地方接受治疗，19%（n=249）参与治疗，3%（n=33）死亡，2%（n=29）未得到随访，32%（n=423）处于 OOC 状态。在联系到的 OOC 患者中（85%，359/423），有 250 名（70%）重新参与，40 名（11%）有预约；其余的无法联系、拒绝治疗或错过了预约。前后结果表明，接受“失落与发现”的人重新参与的可能性高 1.18 倍（95%置信区间 1.02-1.36），重新参与的中位时间早 55 天（95%置信区间 14-98）。
“失落与发现”可能是 OOC 患者重新参与的可行诊所干预措施。需要进行更有力的评估。
