scholarly journals 895. Impact of Telemedicine on HIV Care and Prevention Services at an Academic Ryan White-Funded Clinic

2021 ◽  
Vol 8 (Supplement_1) ◽  
pp. S539-S539
Author(s):  
Jay V Dasigi ◽  
Nupur Gupta ◽  
Christiane Hadi
Keyword(s):  
Retention In Care ◽  
Hiv Care ◽  
Chlamydia Screening ◽  
Screening Rate ◽  
Vaccination Rates ◽  
Prevention Services ◽  
Flu Vaccination ◽  
Ryan White ◽  
Secondary Outcomes ◽  
The Impact

Abstract Background Telemedicine (TM) has been seldom used for the care of persons with HIV. However, the COVID-19 pandemic has forced HIV clinics to rapidly scale TM resources. With the increase of TM, the impact on HIV patient care remains uncertain. The purpose of this study is to examine the effects of TM on HIV care and retention at a Ryan White-funded clinic. Methods This was a retrospective study of patients seen at an academic clinic in Pittsburgh, PA between 1/1/20 – 12/31/20. Encounter information was extracted from the clinic electronic health record. Primary outcomes were viral load (VL) suppression (< 200 copies/ml) and retention in care for persons seen via TM (phone, video +/- in person) vs those seen in-person. Secondary outcomes included flu vaccination and STI screening rates. Results Amongst 1414 patients, 608 patients had at least one scheduled TM visit, with 97 seen exclusively via TM, and 806 were scheduled for only in-person visits. In those with at least one TM visit, 92.72% had a suppressed VL. 89.69% of those with only TM visits were suppressed. 92.43% were suppressed in the in-person group. Average show rate amongst patients who had at least one TM visit was 60.39% (+0.96% from 2019, +1.71% from 2018), vs 64.38% amongst patients who only had in-person visits. Amongst patients who were only scheduled for TM visits, show rate was 83.97%. 40.18% of patients who had at least one TM visit received their flu vaccine in 2020 (-37.45% from 2019, -36.72% from 2018) vs 37.62% who were only seen in-person. Amongst patients who had at least one TM visit, syphilis screening rate was 43.09% (-7.64% from 2019, -8.55% from 2018) vs 43.51% for those seen only in-person. Gonorrhea and chlamydia screening rates were both 42.91% (+9.46% from 2019, +15.27% from 2018 for chlamydia screening; +8.36% from 2019, +14.73% from 2018 for gonorrhea screening). Amongst patients who were exclusively seen in-person gonorrhea screening rate was 48.24% and chlamydia screening rate was 47.57%. Table 1. Characteristics of Patients Seen in 2020 Table 2. Primary and Secondary Outcomes for Patients Seen in 2020 Conclusion VL suppression rates were similar across both groups, but retention in care was highest in the TM-only group. Flu vaccination rates and STI screening were lower in the groups that included TM. TM is an effective method for maintaining VL suppression and retention in care but has room for improvement with provision of preventative services. Disclosures All Authors: No reported disclosures

scholarly journals 896. Examining the Impact of the COVID-19 Pandemic on Delivery of HIV Care and Prevention Services Among Patients in a Ryan White Clinic

2021 ◽  
Vol 8 (Supplement_1) ◽  
pp. S539-S539
Author(s):  
Michelle Zhang ◽  
Sharlay Butler ◽  
Jason Kennedy ◽  
Molly McKune ◽  
Ghady Haidar ◽  
...  
Keyword(s):  
Viral Load ◽  
Viral Suppression ◽  
Retention In Care ◽  
Hiv Treatment ◽  
Hiv Care ◽  
Viral Load Suppression ◽  
Sti Prevention ◽  
Prevention Services ◽  
The Impact ◽  
Non Parametric

Abstract Background We sought to characterize the impact of the COVID-19 pandemic on HIV-related outcomes in a cohort of patients by examining rates of viral load (VL) suppression, retention-in-care, PrEP access, and STIs. Methods This was a single center, retrospective study of adults receiving HIV treatment or HIV/STI prevention services from 01/2019 - 12/2020. HIV outpatient visits were identified through HRSA’s CareWARE. Visits (in-person, telehealth) only included HIV primary care. HRSA core performance measures were utilized (Table 1). STI positivity rates and descriptive characteristics were calculated. New and refill PrEP prescriptions were tabulated. Chi-square tests compared unmatched non-parametric variables; McNemar’s test matched non-parametric variables. Multivariable logistic regression identified variables associated with retention in care and viral suppression. Results 1721 patients received care; 1234 were seen in both years, 334 only in 2019, 153 only in 2020. The number of telehealth visits increased significantly: video (0% to 31%, < 0.001), phone (0% to 0.4%, p < 0.001). Though the proportion of kept appointments increased (57.2% vs 61.2%), the annual retention in care rate decreased from 74.5% to 70.9% (p = 0.002). Overall, 9.7% of patients had detectable VLs at any point. Compared to 2019, a lower proportion of patients maintained VL suppression in 2020, (91.6% vs 83.5% p = 0.075). More patients did not have a VL drawn in 2020 than in 2019 (10.3% vs 2.0 %, p < 0.001). Patients with detectable VLs in 2019 were more likely than those who were undetectable to have detectable VLs in 2020 (OR 18.2, 95% CI 9.91-33.42). Black race was associated with higher likelihood of lack of VL suppression (OR = 2.0; 95% CI 1.10-3.66). There were no significant differences between gender or age groups in rates of viral suppression, number screened for bacterial STIs or positive results. Visits for new and refill PrEP prescriptions decreased by 59% and 7%, respectively. Conclusion Rates of viral load suppression and retention in care decreased in 2020 compared to 2019. The proportion of clinic visits attended increased after the integration of telemedicine in 2020. These data may be used to inform evidence-based interventions to improve the HIV continuum of care through telehealth. Disclosures Ghady Haidar, MD, Karuys (Grant/Research Support)

scholarly journals Impact of a child -friendly clinic on retention of HIV-infected children in care: an intervention study

1970 ◽  
Vol 44 (4) ◽  
pp. 175-179
Author(s):  
OR Ugwu
Keyword(s):  
Highly Active Antiretroviral Therapy ◽  
Retention Rate ◽  
Retention In Care ◽  
Hiv Care ◽  
Satisfaction Survey ◽  
Loss To Follow Up ◽  
Child Friendly ◽  
Children In Care ◽  
The Impact

Background: Certain researchers have reported that a child-friendly clinic may improve patient/caregiver satisfaction at clinic attendance. This could serve as an innovation for reducing loss-to-follow up and increasing retention in care.Aim: To assess the impact of making the clinic more child-friendly on clinic experience, retention in care and loss-to-follow up of HIV -infected children.Method: The study was carried out in three phases. Phase one was a satisfaction survey to find out the patient/caregivers’ satisfaction of the clinic environment and services provided using a selfadministered questionnaire. Phase two was the creation of the childfriendly environment and phase three was a post-provision of child-friendly clinic satisfaction survey. The loss-to-follow up rate (failure to return to clinic ≥3months after the last scheduled clinic appointment in a child not known to be dead or transferred out of the facility) and retention rate (remaining alive and receiving highly active antiretroviral therapy) were also determined before and after setting up the childfriendly clinic.Results: There were 146 respondents before the study and 206 respondents after the intervention. The retention rate increased from 62.5% to 82% (p=0.02), while the loss-to-follow up rate dropped from 27.7% to 7.0% (p=0.00).Conclusion: Making the clinic area child-friendly can impact greatly on HIV care by improving patient satisfaction and retention of HIVinfected children in care and reducing loss-to-follow up.Key words: HIV, child-friendly environment, retention in care, loss to follow-up.

scholarly journals Enhanced Surveillance in a Digital Health Landscape: The Role of the Near-Real Time Right to Care Knowledge Centre within South Africa’s APACE HIV Program

2021 ◽  
Author(s):  
Pisa Pedro ◽  
Potgieter Melinda ◽  
Rennick Marcus ◽  
Chuka Onaga ◽  
Seithati Molefi ◽  
...  
Keyword(s):  
International Development ◽  
Real Time ◽  
Patient Outcomes ◽  
Retention In Care ◽  
The United States ◽  
Hiv Care ◽  
Business Practices ◽  
Program Performance ◽  
Significant Difference ◽  
The Impact

Abstract Introduction: Right to Care (RTC), through support from the United States Agency for International Development (USAID) implements innovations that improve data accessibility and utilization for improved program performance and patient outcomes for large scale HIV care and treatment programs. Frequent and accessible data, coupled with changes to business practices to use that data, allow for targeted and timely HIV program interventions that impact patient outcomes in Ehlanzeni district, Mpumalanga, South Africa.Methods: In South Africa, within the USAID Accelerating Program Achievements to Control the Epidemic (APACE) program, the Knowledge Centre (KC) – an interoperable automated data warehouse and visualization near real-time solution - allow for rapid daily assessment of over- and under-performance cross-sectionally. The authors established the impact of the KC intervention for 29 USAID-selected Siyenza facilities, before the KC intervention (Dec 2018 to Feb 2019) compared to HIV outcomes during the KC intervention (March 2019 to May 2019), stratified by facility classification as included or not included in the Siyenza program using both non-parametric and parametric methodologies.Results: Average facility ART initiations increased by 16% from a monthly average of 54 new initiations pre-Siyenza to 62 new ART initiations during Siyenza; retention increased to a net retention in care ratio of 1.15 indicating that patients labelled as lost to care were brought back. An independent-samples t-test indicated that the net retention in care scores were significantly higher for Siyenza facilities (M =.379, SD =.808) compared to non-Siyenza facilities (M=-.061, SD =1.016), t(208) = 2.224, p < 0.027, d = .445 during the Siyenza period. A significant difference was noted between the means with a 62.3% chance that the Siyenza facilities have a higher observed mean than the non-Siyenza facilities during the intervention period. Results indicate that Siyenza facilities maintain cohort growth, while non-Siyenza facilities continued to lose patients. Conclusion: The accessibility and utilization of near to real-time interoperable data within HIV programs allowed for rapid responses to program performance, needs and improved patient outcomes. Daily data review meetings facilitated precision programming and contributed to the behavior change necessary to institute routine data use for decision making and evaluations within programs.

scholarly journals Differential Role of Psychosocial, Health Care System and Neighborhood Factors on the Retention in HIV Care of Women and Men in the Ryan White Program

2020 ◽  
Vol 19 ◽  
pp. 232595822095008
Author(s):  
Mary Jo Trepka ◽  
Diana M. Sheehan ◽  
Rahel Dawit ◽  
Tan Li ◽  
Kristopher P. Fennie ◽  
...  
Keyword(s):  
Health Assessment ◽  
Retention In Care ◽  
Psychosocial Health ◽  
Retention Rates ◽  
Hiv Care ◽  
Dade County ◽  
Medical Provider ◽  
Enabling Factors ◽  
Retention In Hiv Care ◽  
Ryan White

We investigated potential differential impact of barriers to HIV care retention among women relative to men. Client intake, health assessment, service, and laboratory information among clients receiving medical case management during 2017 in the Miami-Dade County Ryan White Program (RWP) were obtained and linked to American Community Survey data by ZIP code. Cross-classified multilevel logistic regression analysis was conducted. Among 1609 women and 5330 men, 84.6% and 83.7% were retained in care. While simultaneously controlling for all demographic characteristics, vulnerable/enabling factors, and neighborhood indices in the model, younger age, being US born, not working, and having a medical provider with low volume (<10) of clients remained associated with non-retention in care among women and men; while having ≥3 minors in the household and being perinatally infected were additionally associated with retention only for women. Both gender-specific and gender-non-specific barriers should be considered in efforts to achieve higher retention rates.

scholarly journals PO 7139 CONDITIONAL ECONOMIC INCENTIVES AND MOTIVATIONAL INTERVIEWING TO IMPROVE ADOLESCENTS’ RETENTION AND ADHERENCE TO ANTIRETROVIRAL THERAPY IN NIGERIA: ARA TRIAL

2019 ◽  
Vol 4 (Suppl 3) ◽  
pp. A19.2-A19
Author(s):  
Obinna Ekwunife ◽  
Maureen Anetoh ◽  
Stephen Kalu ◽  
George Eleje
Keyword(s):  
Viral Load ◽  
Antiretroviral Therapy ◽  
Motivational Interviewing ◽  
Retention In Care ◽  
Economic Incentives ◽  
Hiv Care ◽  
Incentive Scheme ◽  
Anambra State ◽  
Adherence Support ◽  
The Impact

BackgroundAdolescent HIV patients have worse treatment outcomes compared to other age groups given their vulnerability to risk-taking behaviour. Limited evidence exists on the effectiveness of service delivery interventions to support adolescents’ retention in care and adherence to antiretroviral therapy (ART). The ARA trial tackles this challenge by evaluating the impact of conditional economic incentives coupled with motivational interviewing on adolescents’ retention in care and adherence to ART in Anambra State, Nigeria.MethodsThe study will be a cluster-randomised, controlled trial conducted in 12 HIV treatment hospitals in Anambra State, Nigeria. Six (6) hospitals each will be randomised to either intervention or control arm. A structured adherence support scheme, termed the Incentive Scheme, will be applied to the intervention hospitals while the control hospitals will receive routine HIV care. Additionally, patients in the intervention arm will receive motivational interviewing at baseline and following initiation of ART, they will receive a gift voucher of Nigerian Naira (NGN) 2000 when viral load (VL) is <20 copies/mL at 12 weeks, gift voucher of NGN 1000 if the VL remains suppressed for the next 3 months, and the next 6 months, and finally gift voucher of NGN 2000 if the VL remains <20 copies/mL at 1 year. All gift vouchers will be conditional not only on VL results but also on attending for motivational interviewing. The primary outcome for the trial will be the difference between groups in the proportion to HIV viral load suppression (≤20 copies/mL) by 12 months and then 24 months after withdrawal of the Incentive Scheme.ResultsThe protocol for ARA trial and planned activities is finalised. Application for approval for the trial is on-going.ConclusionThe proposed trial will provide evidence on the feasibility of applying the Incentive Scheme to improve retention and adherence to ART of adolescents living with HIV.

scholarly journals The Impact of Patient’s Socio-Demographic Characterictics, Comorbidities and Attitudes on Flu Vaccination Uptake in Family Practice Settings / Vpliv Bolnikovih Psihosocialnih Značilnosti, Komorbidnosti In Stališč Na Odločitev O Cepljenju Proti Gripi V Ambulantah Družinske Medicine

2015 ◽  
Vol 54 (3) ◽  
pp. 204-211 ◽  
Author(s):  
Andrej Kravos ◽  
Lucija Kračun ◽  
Klara Kravos ◽  
Rade Iljaž
Keyword(s):  
Influenza Vaccination ◽  
Family Physician ◽  
Demographic Data ◽  
Family Physicians ◽  
Office Visits ◽  
Cross Sectional ◽  
Vaccination Rates ◽  
Flu Vaccination ◽  
The Impact ◽  
Beliefs And Attitudes

Abstract Objectives. In Slovenia, the role of family physicians in primary care and preventive procedures is very important. Influenza vaccination rates in Slovenia are low. The reasons for low vaccination rates in Slovenia were not clear. We suppose that patient’s beliefs and attitudes are important factors. We assessed patients’ opinions regarding the acceptance of flu vaccination by their family physicians and their beliefs and attitudes about flu and vaccination. The aim was to check out factors that influence the decision to take the vaccine in family physician offices. Methods. This was a cross-sectional, multicenter, observational study in the Styria region in Slovenia. We included patients from seven family physicians during regular office visits. They filled in a questionnaire about their general demographic data and attitudes regarding influenza and vaccination. The main outcome was the decision to be vaccinated. Results. The logistic regression model identified five predictors for influenza vaccination, namely: heart disease, previous vaccination, an agreement with the beliefs ‘the vaccination is an efficient measure to prevent influenza’, ‘after the vaccination there are usually no important side effects’ and ‘the vaccination is also recommended for a healthy adult person’. The belief that vaccinations harm the immune system is negatively associated with vaccination. Conclusions. Patients’ beliefs are an important factor to decide for vaccination or not. Family physician teams should discuss with patients their beliefs and concerns about vaccination.

scholarly journals HIV Care Continuum and Meeting 90-90-90 Targets: Cascade of Care Analyses of a U.S. Military Cohort

2020 ◽  
Vol 185 (7-8) ◽  
pp. e1147-e1154 ◽  
Author(s):  
Andrew Anglemyer ◽  
Noah Haber ◽  
Adi Noiman ◽  
George Rutherford ◽  
Anuradha Ganesan ◽  
...  
Keyword(s):  
Linkage To Care ◽  
Hiv Infections ◽  
Retention In Care ◽  
Hiv Care ◽  
Secondary Outcome ◽  
Institutional Review Boards ◽  
Institutional Review ◽  
Cascade Of Care ◽  
The Impact ◽  
The U.S

Abstract Introduction The new initiative by the Department of Health and Human Services (DHHS) aims to decrease new HIV infections in the U.S. by 75% within 5 years and 90% within 10 years. Our objective was to evaluate whether the U.S. military provides a good example of the benefits of such policies. Materials and methods We conducted an analysis of a cohort of 1,405 active duty military personnel with HIV enrolled in the Natural History Study who were diagnosed between 2003 and 2015 at six U.S. military medical centers. The study was approved by institutional review boards at the Uniformed Services University of the Health Sciences and each of the sites. We evaluated the impact of Department of Defense (DoD) HIV care policies, including screening, linkage to care, treatment eligibility, and combined antiretroviral therapy (cART) initiation on achieving viral suppression (VS) within 3 years of diagnosis. As a secondary outcome, we evaluated the DoD’s achievement of UNAIDS 90-90-90 targets. Results Nearly all (99%) were linked to care within 60 days. Among patients diagnosed in 2003–2009, 77.5% (95% confidence intervals (CI) 73.9–80.6%) became eligible for cART within 3 years of diagnosis, 70.6% (95% CI 66.6–74.1%) overall initiated cART, and 64.2% (95% CI 60.1–68.0%) overall achieved VS. Among patients diagnosed in 2010–2015, 98.7% (95% CI 96.7–99.5%) became eligible for cART within 3 years of diagnosis, 98.5% (95% CI 96.4–99.4%) overall initiated cART, and 89.8% (95% CI 86.0–92.5%) overall achieved VS. Conclusions U.S. military HIV policies have been highly successful in achieving VS goals, exceeding the UNAIDS 90-90-90 targets. In spite of limitations, including generalizability, this example demonstrates the feasibility of the DHHS initiative to decrease new infections through testing, early treatment, and retention in care.

scholarly journals Retention in Care Services Reported by HIV Care Providers in the United States, 2013 to 2014

2017 ◽  
Vol 16 (5) ◽  
pp. 460-466 ◽  
Author(s):  
Jason A. Craw ◽  
Heather Bradley ◽  
Garrett Gremel ◽  
Brady T. West ◽  
Christopher C. Duke ◽  
...  
Keyword(s):  
Barriers To Care ◽  
Retention In Care ◽  
The United States ◽  
Hiv Care ◽  
Care Providers ◽  
Care Services ◽  
Ryan White ◽  
Aids Program ◽  
Evidence Based Guidelines ◽  
New Strategies

Objectives: Evidence-based guidelines recommend that HIV care providers offer retention-in-care services, but data are needed to assess service provision. Methods: We surveyed a probability sample of 1234 HIV care providers to estimate the percentage of providers whose practices offered 5 recommended retention services and describe providers’ perceptions of barriers to care among patients. Results: An estimated 21% of providers’ practices offered all 5 retention services. Providers at smaller (<50 versus >400 patients), private, and non-Ryan White HIV/AIDS Program (RWHAP)-funded practices, and practices without on-site case management were significantly less likely to provide patient navigation services or do systematic monitoring of retention. Providers’ most commonly perceived barriers to care among patients were mental health (40%), substance abuse (36%), and transportation (34%) issues. Conclusion: Deficiencies in the provision of key retention services are substantial. New strategies may be needed to increase the delivery of recommended retention services, especially among private, non-RWHAP-funded, and smaller facilities.

The Impact of Gavi on Vaccination Rates: Regression Discontinuity Evidence

2015 ◽  
Author(s):  
Sarah Dykstra ◽  
Amanda L. Glassman ◽  
Charles Kenny ◽  
Justin Sandefur
Keyword(s):  
Regression Discontinuity ◽  
Vaccination Rates ◽  
The Impact

scholarly journals Bijou: Engaging Young MSM in HIV Care Using a Mobile Health Strategy

2021 ◽  
Vol 20 ◽  
pp. 232595822110308
Author(s):  
Tiffany Chenneville ◽  
Hunter Drake ◽  
Kemesha Gabbidon ◽  
Carina Rodriguez ◽  
Lisa Hightow-Weidman
Keyword(s):  
Health Literacy ◽  
Self Efficacy ◽  
Retention In Care ◽  
Knowledge Retention ◽  
Hiv Care ◽  
Ehealth Literacy ◽  
Literacy Engagement ◽  
Southeastern Us ◽  
Post Test ◽  
Living With Hiv

Young men who have sex with men (YMSM) living with HIV experience challenges with retention in care, which negatively affects viral suppression. To address this, researchers piloted Bijou, a program designed to provide health education through electronically delivered behavior and risk reduction modules. Participants were 29 YMSM aged 19-24 living with HIV from the southeastern US. Participants completed pre, post, and 3-month follow-up (3MFU) surveys assessing knowledge, intervention acceptability, satisfaction, self-efficacy, ehealth literacy, and usability. Findings revealed significant improvement in knowledge and e-health literacy from pre-test to post-test but lost significance at 3MFU. Self-efficacy scores did not show significant differences from pre-test to post-test or 3MFU. Participants who completed all modules considered Bijou usable and acceptable; however, many did not complete the program. Findings suggest a need for adaptations to promote knowledge retention, e-health literacy, engagement over time, and research with a larger, more representative sample.

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