Abstract
BackgroundAt the McGill University Health Centre (MUHC), 10% of patients living with HIV do not return for care annually. Currently, no formal system exists to re-engage out-of-care (OOC) patients. Lost & Found, developed using an implementation science approach, is an intervention to re-engage OOC patients. It is based on existing evidence-based interventions and will be adapted for use by nurses at the MUHC. The aims of this study are to simultaneously assess both implementation and effectiveness of Lost & Found in order to determine the viability of a future multisite stepped-wedge cluster randomised trial.MethodsLost & Found consists of two core elements: identifying and contacting OOC patients. Based on formative work involving MUHC nurses, and the use of a combined implementation framework (enhanced Replicating Effective Programs, Tailored Implementation for Chronic Diseases, and Proctor et al.’s implementation outcomes), we will adapt the intervention to our clinic. Adaptations include the creation of an OOC risk prediction tool, an automated real-time OOC list, and prioritization of high-risk OOC patients for re-engagement. Delivery and ongoing adaptation of the intervention will follow a three-pronged implementation strategy consisting of (1) promoting adaptability; (2) planning, engaging, executing, evaluating, and reflecting cycles; and (3) internal facilitation. This 15-month quasi-experimental pilot study adopts a type II implementation-effectiveness hybrid design. To evaluate implementation, a convergent parallel mixed-methods approach will guide the mixing of qualitative and quantitative data at time points throughout the study. In addition, descriptive and pre-post analyses, for each of the implementation and sustainability phases, will inform evaluations of the cumulative effectiveness and sustainability of the Lost & Found intervention.DiscussionThis study will provide preliminary evidence for (1) the utility of our chosen implementation strategies and (2) the effectiveness of the intervention. Ultimately, this information may be used to inform future re-engagement efforts using implementation science in other HIV care centres. In addition, the procedures and measurement tools developed for this study will be foundational to the development of a multi-site, randomised stepped wedge study that would provide more robust evidence in support of the Lost & Found intervention.
Highlights
At the McGill University Health Centre (MUHC), 10% of patients living with Human immunodeficiency virus (HIV) do not return for care annually
The UNAIDS 90-90-90 targets have set ambitious and necessary global goals for improving the HIV care cascade and tackling the HIV epidemic by 2030 [1]. The latter two targets seek to ensure that 90% of people diagnosed with HIV are prescribed combination antiretroviral therapy and that 90% of these people have suppressed HIV viral loads (VL)
The cascade of HIV care has been assessed at the McGill University Health Centre (MUHC) in Montreal, Quebec
Summary
At the McGill University Health Centre (MUHC), 10% of patients living with HIV do not return for care annually. Lost & Found, developed using an implementation science approach, is an intervention to re-engage OOC patients It is based on existing evidencebased interventions and will be adapted for use by nurses at the MUHC. The UNAIDS 90-90-90 targets have set ambitious and necessary global goals for improving the HIV care cascade and tackling the HIV epidemic by 2030 [1]. The latter two targets seek to ensure that 90% of people diagnosed with HIV are prescribed combination antiretroviral therapy (cART) and that 90% of these people have suppressed HIV viral loads (VL). Developing and testing interventions to re-engage PLHIV into care should be prioritised
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