Featured news from NHIVNA
HIV-related news from NAM
Telephone intervention can boost retention in care for HIV-positive patients with mental health and drug/alcohol problems
Michael Carter, 2016-02-17 07:50:00
Retention in HIV
care among patients with mental health and/or drug and alcohol problems can be
improved with a telephone-based support intervention, but only if staff are
able to establish regular contact with patients, investigators from the United
States report in AIDS. Overall
results of the study showed that enhanced support – regular contact with reminder
to attend appointments and follow-up after missed appointments – did not
improve retention in care among patients with anxiety, depression and drug and
alcohol problems. However, closer analysis of the results revealed that the
intervention did work when staff were able to contact patients.
“Looking at these
higher-risk patients as a whole, without considering delivery of the
intervention, one would conclude that patients did not respond well to the
intervention,” write the investigators. “But a more nuanced picture emerged. We
found that the intervention arm patients in the higher-risk group received less
contact…a significant percentage did receive most of the intervention elements,
and this part did, in fact, benefit from the intervention.”
therefore believe that patients living with mental health and substance abuse
problems who have dropped out of care can be re-engaged, provided they can be
contacted and supported.
The CDC estimates
that 45% of patients with diagnosed HIV infection in the US are not fully
engaged with care and therefore are unlikely to be getting the full benefit of
antiretroviral therapy. Mental health and substance abuse problems are highly
prevalent among HIV-positive individuals in the US and are a possible reason
why some patients disengage with care.
designed an intervention to boost clinic attendance among patients who had
dropped out of care. Consisting of
reminder calls, missed visit calls, interim visit calls and brief face-to-face meetings
in clinic, it was shown to improve retention among patients with irregular
wanted to see if the intervention could successfully boost clinic attendance
among patients living with potential barriers to engagement with care, such as
severe anxiety, depression, heavy drinking and illicit drug use.
They conducted a
sub-analysis of their principal findings. The study population consisted of
1838 patients who received care at six HIV clinics. All had irregular clinic
attendance patterns. Their mental health and drug/alcohol use was assessed
using accredited measures. Patients were randomised to receive the enhanced support
intervention or standard of care for twelve months. The study outcome was
attendance at regular outpatient follow-up visits over the next year.
Over two-thirds of
patients were African American, approximately 60% were men and a third were in
their 40s. At baseline, 78% were taking ART and approximately 56% had an
undetectable viral load.
A fifth reported
using illicit drugs in the previous three months and 15% were classified as
heavy drinkers. Severe anxiety/depression was present in 14% of participants.
showed that the intervention did not boost clinic attendance among patients
facing drug/alcohol or mental health issues.
Patients were then
categorised according to their risk of dropping out of care. Over a third (36%)
had one or more risk factor – such as mental health or substance abuse problems
– for irregular clinic attendance. Analysis of the efficacy of the intervention
according to risk profile showed that it had a strong, positive effect among
low-risk patients, boosting the chances of engagement with care by 35% (p <
0.009). However, it did not have a positive effect for higher-risk individuals.
noted higher-risk patients were contacted on 41% of attempted telephone contacts,
compared to a success rate of 51% for lower-risk individuals, a significant
difference. The lower success rate with higher-risk patients was not due to fewer
attempted contacts (mean 16 attempts for both groups).
showed that the intervention had a strongly positive effect (equal to that
observed in low-risk patients) for higher-risk patients who received at least
60% of attempted telephone contacts.
percent of the higher-risk participants in the intervention arm had at least
60% successful contacts and exhibited a strong response to the intervention,”
write the authors. “These phone contact results for the higher-risk group give
us confidence that there are some patients at high risk of disengaging from
care who will respond to an enhanced contact-type intervention.”
They conclude, “improving
receipt of the intervention among higher-risk patients may be possible by
simply altering the enhanced contact intervention to more effectively stay in
contact with these patients. This concept is supported by other research
findings that more intense and frequent contact from HIV care managers resulted
in fewer gaps in care.”