Patient Retention In Care Research Articles

Projected health and economic effects of a pan-tuberculosis treatment regimen: a modelling study

A pan-tuberculosis regimen that could be initiated without knowledge of drug susceptibility has been proposed as an objective of tuberculosis regimen development. We modelled the health and economic benefits of such a regimen and analysed which of its features contribute most to impact and savings. We constructed a mathematical model of tuberculosis treatment parameterised with data from the published literature specific to three countries with a high tuberculosis burden (India, the Philippines, and South Africa). Our model simulated cohorts of newly diagnosed tuberculosis patients, including drug susceptibility testing if performed, regimen assignment, discontinuation, adherence, costs, and resulting outcomes of durable cure (microbiological cure without relapse), need for retreatment, or death. We compared a pan-tuberculosis regimen meeting the WHO 2023 target regimen profile against the standard of care of separate rifampicin-susceptible and rifampicin-resistant regimens. We estimated incremental cures; averted deaths, secondary cases, and costs; and prices below which a pan-tuberculosis regimen would be cost saving. We also assessed scenarios intended to describe which mechanisms of benefit from a pan-tuberculosis regimen (including improved characteristics compared with the current rifampicin-susceptible and rifampicin-resistant regimens and improved regimen assignment and retention in care for patients with rifampicin-resistant tuberculosis) would be most impactful. Results are presented as a range of means across countries with the most extreme 95% uncertainty intervals (UIs) from the three UI ranges. Compared with the standard of care, a pan-tuberculosis regimen could increase the proportion of patients durably cured after an initial treatment attempt from 69-71% (95% UI 57-80) to 75-76% (68-83), preventing 30-32% of the deaths (20-43) and 17-20% of the transmission (9-29) that occur after initial tuberculosis diagnosis. Considering savings to the health system and patients during and after the initial treatment attempt, the regimen could reduce non-drug costs by 32-42% (22-49) and would be cost saving at prices below US$170-340 (130-510). A rifamycin-containing regimen that otherwise met pan-tuberculosis targets yielded only slightly less impact, indicating that most of the benefits from a pan-tuberculosis regimen resulted from its improvements upon the rifampicin-susceptible standard of care. Eliminating non-adherence and treatment discontinuation, for example via a long-acting injectable regimen, increased health impact and savings. In countries with a high tuberculosis burden, a shorter, highly efficacious, safe, and tolerable regimen to treat all tuberculosis could yield substantial health improvements and savings. Bill & Melinda Gates Foundation.

Long-term impact of an integrated HIV/non-communicable disease care intervention on patient retention in care and clinical outcomes in East Africa.

To describe rates of retention in care and control of hypertension, diabetes and HIV among participants receiving integrated care services for a period of up to 24 months in East Africa. Between 5 October 2018 and 23 June 2019 participants enrolled into a prospective cohort study evaluating the feasibility of integrated care delivery for HIV, diabetes and hypertension from a single point of care in Tanzania and Uganda (MOCCA study). Integrated care clinics were established in 10 primary healthcare facilities and care was provided routinely according to national guidelines. Initial follow-up was 12 months. Outcomes were rates of retention in care, proportions of participants with controlled hypertension (blood pressure <140/90 mmHg), diabetes (fasting blood glucose <7.0 mmol/L) and HIV (plasma viral load <1000 copies/ml). The study coincided with the COVID-19 pandemic response. Afterwards, all participants were approached for extended follow-up by a further 12 months in the same clinics. We evaluated outcomes of the cohort at the end of long-term follow-up. The MOCCA study enrolled 2273 participants of whom 1911 (84.5%) were retained in care after a median follow-up of 8 months (Interquartile range: 6.8-10.7). Among these, 1283/1911 (67.1%) enrolled for a further year of follow-up, 458 (24.0%) were unreachable, 71 (3.7%) reverted to vertical clinics (clinics providing services dedicated to study conditions), 31 (1.6%) died and 68 (3.6%) refused participation. Among participants who enrolled for longer follow-up, mean age was 51.4 ± 11.7 years, 930 (72.5%) were female and 509 (39.7%) had multiple chronic conditions. Overall, 1236 (96.3%) [95% confidence interval 95.2%-97.3%] participants were retained in care, representing 1236/2273 (54.3%) [52.3%-56.4%] of participants ever enrolled in the study. Controlled hypertension, diabetes and HIV at the end of follow-up was, 331/618 (53.6%) [49.5%-57.5%], 112/354 (31.6%) [26.8%-36.8%] and 332/343 (96.7%) [94.3%-98.4%] respectively. Integrated care can achieve high rates of retention in care long term, but control of blood pressure and blood sugar remains low.

Health insurance financing and patient retention in care at diabetics and hypertension clinics in Dar es Salaam and Pwani regions, Tanzania. A cohort study.

Hypertension and diabetes are chronic conditions that cause major morbidity and mortality worldwide. Whether health insurance financing is associated with improved retention in chronic care in Tanzania, is unknown. Our study establishes the effect of health insurance on retention and the determinants for retention in care among patients attending diabetes and hypertension clinics. We used a Cohort design to study participants enrolled in a cluster-randomized trial of integrated management of HIV, diabetes, and hypertension compared with standard vertical care in the INTE-AFRICA trial. Fifteen health facilities in Dar es Salam and Pwani regions were enrolled, with 1716 participants. Our sample size had 95% power to detect a 50% to 60% retention difference between the insured and uninsured groups (95% CI). We compared proportions using χ2 tests and obtained prevalence and rate ratios by Generalised Linear Models. We studied 1716 participants for 1612.3 Person-years (PY). At the study's end, 1351 persons were alive and retained in care. Among the insured participants (26.0%), females accounted for 65.9%. Middle-aged adults contributed 58.8% of insured participants. We observed high retention rates (retention incidence rate IR: 83.80/100 PY; 95% CI (79.40-88.40)). There was no difference in retention among insured and uninsured patients (adjusted rate ratio aRR: 1.00; 95% CI, 0.94-1.06). Being middle-aged or senior-aged adults compared to young adults, having diabetes alone or hypertension alone compared to both conditions, having the comorbidity of diabetes or hypertension with HIV compared to a single condition, and attending health centres and hospitals compared to dispensaries were significantly associated with retention in care. This study showed no effect of health insurance on retention in diabetic and hypertension care clinics. However, age, medical diagnosis, morbidity, and type of health facility attended were associated with retention in care.

The Capacity of HIV Care Facilities to Implement Strategies Recommended by the Ending the HIV Epidemic-The Medical Monitoring Project Facility Survey.

Data are needed to assess the capacity of HIV care facilities to implement recommended Ending the HIV Epidemic (EHE) activities. U.S HIV care facilities. We analyzed 2021 survey data from a census of 514 facilities providing care to a national probability sample of U.S. adults with HIV. We present weighted estimates of facility characteristics, services, and policies, and estimates of the proportion of all U.S. HIV patients attending these facilities. Among HIV care facilities, 37% were private practices, 72% were in areas with population > 1 million, and 21% had over 1000 HIV patients. Most provided preexposure prophylaxis (PrEP, 83%) and postexposure prophylaxis (PEP, 84%). Over 67% of facilities provided HIV-specific stigma or discrimination training for all staff (covering 70% of patients) and 66% provided training on cultural competency (covering 74% of patients). A majority of patients attended facilities that provided on-site access to HIV/STI transmission risk reduction counseling (89%); fewer had on-site access to substance use disorders treatment (35%). We found low provision of on-site assistance with food banks or meal delivery (14%) and housing (33%). Approximately 71% of facilities reported using data to systematically monitor patient retention in care. On-site access to adherence tools was available at 58% of facilities; 29% reported notifying patients of missed prescription pickups. Results indicate some strengths that support EHE-recommended strategies among HIV care facilities, such as high availability of PrEP/PEP, as well as areas for improvement, such as provision of staff anti-stigma trainings and adherence supports.

Assessing HIV-infected patient retention in a program of differentiated care in sub-Saharan Africa: a G-estimation approach.

Differentiated care delivery aims to simplify care of people living with HIV, reflect their preferences, reduce burdens on the healthcare system, maintain care quality and preserve resources. However, assessing program effectiveness using observational data is difficult due to confounding by indication and randomized trials may be infeasible. Also, benefits can reach patients directly, through enrollment in the program, and indirectly, by increasing quality of and accessibility to care. Low-risk express care (LREC), the program under evaluation, is a nurse-centered model which assigns patients stable on ART to a nurse every two months and a clinician every third visit, reducing annual clinician visits by two thirds. Study population is comprised of 16,832 subjects from 15 clinics in Kenya. We focus on patient retention in care based on whether the LREC program is available at a clinic and whether the patient is enrolled in LREC. We use G-estimation to assess the effect on retention of two "strategies": (i) program availability but no enrollment; (ii) enrollment at an available program; versus no program availability. Compared to no availability, LREC results in a non-significant increase in patient retention, among patients not enrolled in the program (indirect effect), while enrollment in LREC is associated with a significant extension of the time retained in care (direct effect). G-estimation provides an analytical framework useful to the assessment of similar programs using observational data.

Age, ethnicity and proximity to clinic determine retention in care of chronic hepatitis B patients.

Patient retention in care is an essential component of the viral hepatitis care continuum. The aim of this study was to define rates and determinants of retention in care for chronic hepatitis B patients. We used several electronic data sources including patient administrative data, electronic clinical records, laboratory data and electronic prescribing records to examine a multi-ethnic cohort of patients attending a single hepatitis B clinic during a 21-year period. After exclusions, we studied of a cohort of 2,447 patients. Retention in care was 73.2%, 64.1%, 55.6% and 50.3% at 5, 10, 15 and 20 years of follow-up. Asian ethnicity and older age at baseline were associated with lower rates of loss to follow-up. Increasing distance from the patient's current residence to the Liver Clinic was strongly associated with loss to follow-up. Our findings suggest that interventions to maintain retention in care in the United Kingdom should particularly focus on younger patients and on patients with non-Asian ethnicity.

Successful expanded clinic network collaboration and patient tracing for retention in HIV care

BackgroundThere are more than 7,800 people living with human immunodeficiency virus (HIV) in Victoria, Australia. Crucial in maximising the individual and population level benefits from antiretroviral therapy (ART) is understanding how to achieve patient retention in care and the factors that drive it. This study was an expansion of a 2015 assessment of HIV-care retention in Victoria, which sought out to determine whether the inclusion of a broader range of HIV-healthcare sites would yield more accurate estimates of retention in HIV-care. We aimed to improve our understanding of HIV-care retention in Victoria, Australia, identify people living with HIV (PLHIV) with unknown outcomes, and attempt to re-engage PLHIV in care.MethodsA network of 15 HIV-care sites was established in Victoria, Australia across diverse care settings which ranged from low-caseload rural sites to high-caseload metropolitan GP clinics and hospitals. Individuals who had an HIV viral load (VL) performed in both calendar years of 2016 and 2017 were classified as retained in care. Individuals with a VL test in 2016 but not in 2017 were considered to potentially have unknown outcomes as they may have been receiving care elsewhere, have disengaged from care or died. For this group, an intervention of cross-referencing partially de-identified data between healthcare sites, and contact tracing individuals who still had unknown outcomes was performed.ResultsFor 5223 individuals considered to be retained in care across 15 healthcare sites in the study period, 49 had unconfirmed transfers of care to an alternative provider and 79 had unknown outcomes. After the intervention, the number of unconfirmed care transfers was reduced to 17 and unknown outcomes reduced to 51. These changes were largely attributed to people being reclassified as confirmed transfers of care. Retention in care estimates that did not include the patient outcome of confirmed transfer of care ranged from 76.2 to 95.8% and did not alter with the intervention. However, retention in care estimates which considered confirmed transfers and those that re-entered care at a new site as retained in care significantly increased across five of the sites with estimates ranging from 80.9 to 98.3% pre-intervention to 83.3–100% post-intervention. Individuals whose outcomes remained unknown post-intervention were more often men who have sex with men (MSM) when compared to other categories (person who injects drugs (PWID), combined PWID/MSM, men who identify as heterosexual or unknown) (74.5% vs. 53.5%, [p = 0.06]) and receiving ART at their last HIV-care visit (84.3% vs. 67.8% [p = 0.09]).ConclusionThis study confirmed high retention in HIV-care and low numbers of people disengaged from HIV-care in Victoria. This was demonstrated across a larger number of sites with varying models of care than a prior assessment in 2015. These data align with national and state targets aiming for 95% of PLHIV retained in HIV-care.

Early impact of the PEN HEARTS package to manage noncommunicable diseases in Bhutan: a mixed-methods evaluation

Introduction: Non-communicable diseases (NCDs) pose significant public health challenges in Bhutan. In 2019, Bhutan’s Ministry of Health introduced a set of interventions associated with the World Health Organization’s Package of Essential Noncommunicable Disease Interventions for Primary Health Care in Low-Income Settings called PEN HEARTS. This initiative encompassed six components: healthy lifestyle intervention, evidence-based protocols, access to medicines and technology, risk-based management, team-based care, and systems monitoring. Evaluations of PEN interventions in other countries documented barriers to implementation. The present report provides the result of a 2019–2020 evaluation assessing implementation of PEN HEARTS in Bhutan and initial impacts on provision of care for NCDs and patient outcomes. Methods: A cross-sectional, mixed-methods evaluation was conducted in six districts, two where the interventions were first initiated, two where they were implemented subsequently, and two where no implementation had begun. In each district, data were collected at the district hospital and three basic health units. Quantitative data collection encompassed facility checklists, health worker surveys, and patient record abstraction. For the survey, health workers were selected using random or convenience sampling depending on facility size. For patient record abstraction, enumerators created a sampling frame at each facility to include eligible patients who were then selected randomly for record review. Qualitative data collection included in-depth interviews (IDIs) with health workers, and IDIs with NCD patients. A convenience sample of health worker IDI participants was selected randomly at hospitals; all health workers at BHUs were invited to participate. A convenience sample of NCD patients was recruited from facility waiting rooms on the day(s) of data collection. Lastly, a convenience sample of homebound patients was recruited to participate in IDIs. Quantitative analysis methods included bivariate analysis of categorical and continuous variables, and pairwise comparisons among groups. Qualitative data were analyzed using thematic content analysis with inductive coding. Results: A total of 153 health workers participated in the knowledge survey and 121 patient records were reviewed. IDIs were conducted with 13 health workers, 18 hospital or BHU patients, and four homebound patients. Most elements of the PEN HEARTS program were implemented as planned, including monitoring and supervision. PEN HEARTS had a positive impact on disease control: group A districts had a significantly lower proportion of patients with a treatment gap (p<0.001) and a significantly higher proportion of patients retained in care (p<0.001). Health workers experienced implementation challenges in four main areas: human resources, medicine shortages, equipment failure, and record-keeping. They also described benefits from increased supervision and peer support. Patients described experiencing more patient-centered care and overall positive experiences with the program. Conclusion: The evaluation identified areas of PEN HEARTS implementation that should be strengthened and improved, particularly training, record-keeping, and the use of AUDIT and cardiovascular disease risk assessments. The evaluation also showed evidence of improved disease control across achievement of treatment goals, reduction of treatment gaps, and improved patient retention in care. PEN HEARTS has potential to make a difference for NCD patients, and focusing on improving future implementation may further yield benefits in Bhutan.

Retention in care and predictors of attrition among HIV-infected patients who started antiretroviral therapy in Kinshasa, DRC, before and after the implementation of the 'treat-all' strategy.

The retention of patients in care is a key pillar of the continuum of HIV care. It has been suggested that the implementation of a "treat-all" strategy may favor attrition (death or lost to follow-up, as opposed to retention), specifically in the subgroup of asymptomatic people living with HIV (PLWH) with high CD4 counts. Attrition in HIV care could mitigate the success of universal antiretroviral therapy (ART) in resource-limited settings. We performed a retrospective study of PLWH at least 15 years old initiating ART in 85 HIV care centers in Kinshasa, Democratic Republic of Congo (DRC), between 2010 and 2019, with the objective of measuring attrition and to define factors associated with it. Sociodemographic and clinical characteristics recorded at ART initiation included sex, age, weight, height, WHO HIV stage, pregnancy, baseline CD4 cell count, start date of ART, and baseline and last ART regimen. Attrition was defined as death or loss to follow-up (LTFU). LTFU was defined as "not presenting to an HIV care center for at least 180 days after the date of a last missed visit, without a notification of death or transfer". Kaplan-Meier curves were used to present attrition data, and mixed effects Cox regression models determined factors associated with attrition. The results compared were before and after the implementation of the "treat-all" strategy. A total of 15,762 PLWH were included in the study. Overall, retention in HIV care was 83% at twelve months and 77% after two years of follow-up. The risk of attrition increased with advanced HIV disease and the size of the HIV care center. Time to ART initiation greater than seven days after diagnosis and Cotrimoxazole prophylaxis was associated with a reduced risk of attrition. The implementation of the "treat-all" strategy modified the clinical characteristics of PLWH toward higher CD4 cell counts and a greater proportion of patients at WHO stages I and II at treatment initiation. Initiation of ART after the implementation of the 'treat all" strategy was associated with higher attrition (p<0.0001) and higher LTFU (p<0.0001). Attrition has remained high in recent years. The implementation of the "treat-all" strategy was associated with higher attrition and LTFU in our study. Interventions to improve early and ongoing commitment to care are needed, with specific attention to high-risk groups to improve ART coverage and limit HIV transmission.

Integrated multi-month dispensing of antihypertensive and antiretroviral therapy to sustain hypertension and HIV control

Multi-month dispensing (MMD) is a patient-centered approach in which stable patients receive medicine refills of three months or more. In this pre-post longitudinal study, we determined hypertension and HIV treatment outcomes in a cohort of hypertensive PLHIV at baseline and 12 months of receiving integrated MMD. At each clinical encounter, one healthcare provider attended to both hypertension and HIV needs of each patient in an HIV clinic. Among the 1,082 patients who received MMD, the mean age was 51 (SD = 9) years and 677 (63%) were female. At the start of MMD, 1,071(98.9%) patients had achieved HIV viral suppression, and 767 (73.5%) had achieved hypertension control. Mean blood pressure reduced from 135/87 (SD = 15.6/15.2) mmHg at the start of MMD to 132/86 (SD = 15.2/10.5) mmHg at 12 months (p < 0.0001). Hypertension control improved from 73.5% to 78.5% (p = 0.01) without a significant difference in the proportion of patients with HIV viral suppression at baseline and at 12 months, 98.9% vs 99.0% (p = 0.65). Patients who received MMD with elevated systolic blood pressure at baseline were less likely to have controlled blood pressure at 12 months (OR-0.9, 95% CI, 0.90,0.92). Overall, 1,043 (96.4%) patients were retained at 12 months. Integrated MMD for stable hypertensive PLHIV improved hypertension control and sustained optimal HIV viral suppression and retention of patients in care. Therefore, it is feasible to provide integrated MMD for both hypertension and HIV treatment and achieve dual control in the setting of sub-Saharan Africa.

Retention in Care, Loss to Follow-up and Associated Patient Characteristics: A Retrospective Cohort Study among Adults Receiving Antiretroviral Therapy from Urban Health Facilities in Ghana

Abstract Introduction: Assessing treatment outcomes among persons receiving antiretroviral therapy (ART) for human immunodeficiency virus (HIV) infection is important for clinical and public health decisions. Although Komfo Anokye Teaching Hospital and Suntreso Government Hospital have offered ART to several patients for more than a decade, their treatment outcomes have not been well reported. We aimed at investigating retention in care, loss to follow-up, and patient characteristics associated with these outcomes among HIV-infected adults receiving ART from two urban treatment sites in the Ashanti Region of Ghana in order to design interventions to improve therapy outcomes. Materials and method: We conducted medical records review (MRR) from September to December 2020 among HIV-infected patients receiving ART from two urban ART sites in Kumasi, Ghana. Patients were eligible if they were adults aged ≥ 20-years and had taken ART for ≥ 3-years as of December 2019. Retention in care, loss to follow-up (LTFU) and mortality among our study patients were investigated from ART initiation up to 3-years. In this study, retention of patients in care was defined as actively attending clinic and picking ARVs within the follow-up period. Loss to follow-up was defined as having discontinued clinic attendance and ARVs pick-up for more than 90 days after the last scheduled visit. Logistic regression analyses were performed to study the treatment outcomes and their associated patient characteristics. Results: Of the 370 patients whose medical records were reviewed, 258 (69.7%) were female, 260 (70.3%) were retained in ART up to 3-years, 29.7% were lost to follow-up of whom 9.1% were confirmed dead. Overall mortality was therefore 2.7%. Being employed (AOR 2.55, p = 0.015, 95% CI 1.201-5.4.414), female (AOR 1.319, CI 95% 0.754-2.310), divorced (AOR 1.266, CI 95% 0.506-3.166) and having primary level of education (AOR 1.539, CI 95% 0.915-2.590) were associated with greater odds of being retained in care. Conclusion: Although mortality among our study cohort was low and bout 70% were retained in ART up to 3-years, loss to follow-up was high, especially within the first 6 months. Effective follow-up interventions are required to reduce LTFU during the first 6 months of treatment and among younger adults, patients with secondary and tertiary education as well as single and married patients who were less likely to be retained in care.

Lessons from two SARS-CoV-2 waves in South Africa

Lessons from two SARS-CoV-2 waves in South Africa

Telemedicine for HIV Care: Current Status and Future Prospects.

Due to the COVID-19 pandemic, the use of telemedicine has been highlighted, especially in specialties, such as the management of HIV. Recent data were reviewed between January 1, 2019 and March 20, 2021 by searching English language manuscripts for studies documenting clinical outcomes in HIV care and the patient experience. A PubMed, Google Scholar, and bibliography review based on the search terms “HIV,” “telemedicine,” and “telehealth” was conducted. Studies included in this analysis were comprised of adult patients living with HIV, receiving care for HIV via telemedicine with reported clinical outcomes or perceptions of using telemedicine in the management of their HIV care. Of the 179 studies identified, 12 met inclusion for this analysis. Only two studies provided data on clinical outcomes of HIV (virologic outcomes), one pre-pandemic and one during COVID-19. The study evaluating viral suppression during COVID-19 demonstrated lower rates of virologic suppression and lower rates of missed appointments when shelter-in-place orders were issued compared to before the start of the pandemic. The remaining studies focused on patient-related outcomes as they related to the usability and adoption of telehealth models. Many practices documented the benefits and limitations of telemedicine based on the rapid switch from traditional in-person clinics. Benefits included retention in care for patients who lived a far distance from clinic, privacy for patients not wanting to be seen attending an HIV clinic, and more flexibility in scheduling appointments. Some limitations included patients’ access to technology, ability and willingness to use technology, and privacy of patients who are homeless and reside in a shelter where homelessness is 3 times greater in people living with HIV compared to the general population. Healthcare should be tailored to the individual patient by assessing their needs and limitations, particularly with patients who may be at risk for discontinuation of care, particularly in the homeless population. In addition, there are mixed data on factors such as age, sex, and race being limiting factors in willingness to use technology. From the studies reviewed, willingness to engage with technology did not differ by age, sex, or race but did differ by access and willingness to use technology. Greater limitations were access to appropriate devices for telemedicine and digital literacy. Although there have been difficulties with the switch to telemedicine in clinics during the COVID-19 pandemic, many patients have reported being satisfied with care and would be interested in continuing once the shelter-in-place order is lifted. Future studies should focus on the provision of HIV care using telemedicine beyond the pandemic and focus on ways to improve the telemedicine experience for the patient.

Retention of pediatric patients in care: a study of the Kibera Community Health Center HIV/AIDS Program

Background: In 2011, 3.4 million children were living with HIV worldwide1.&#x0D; Objectives: Describe the characteristics of pediatric patients enrolled into the HIV program at the Kibera community health center between January 2012 and March 2013. Determine the proportion of enrolled paediatric patients lost to follow up. Determine the correlates associated with retention and loss to follow up.&#x0D; Methods: The study was a retrospective cohort study of program data of all pediatric patients enrolled into the HIV pro- gram in the facility between January 2012 and March 2013. The data was analyzed using SPSS.&#x0D; Results: Of the 100 pediatric patients enrolled during the study period, 79 and 21 were HIV negative and positive respec- tively. Only 4 (5%) of the HIV exposed Infants and 11 (52%) of the HIV positive children were started on ART within the study period. The retention rate of the children at 3 months was 87% while the retention at both 12 and 15 months was 79%. There was an association between the mother or guardian disclosing their status and the retention of the child (p-value 0.026).&#x0D; Conclusion: The disclosure of the HIV status by parent/guardian to the child was associated with better retention of the children in the program.&#x0D; Keyword: Pediatric patients in care; Kibera community health center; HIV/AIDS.

PHONE CALLS FOR IMPROVING BLOOD PRESSURE CONTROL AMONG HYPERTENSIVE PATIENTS ATTENDING PRIVATE MEDICAL PRACTITIONERS IN INDIA: FINDINGS FROM MUMBAI HYPERTENSION PROJECT

Objective: Despite the availability of effective medication, blood pressure control rate is low, particularly in low- and middle-income countries. Adherence to medication and follow-up visits are important factors in blood pressure control. This study assessed the effectiveness of reminder telephone calls on follow-up visits and blood pressure control among hypertensive patients as part of the Mumbai Hypertension Project. This project was initiated by PATH with the support from Resolve to Save Lives (RTSL) from January 2019 to February 2020. The study included hypertensive patients attending 164 private practitioners in Mumbai, India; practitioners screened all adults visiting clinic during the project period. Among 13184 hypertensive patients registered, the mean age was 53 years (SD = 12.38), 52% were female and 96% provided phone number. 9528 (72%) patients responded to a telephone call at least once during the study period. 82% of patients visited the clinic for follow-up visit within one month after receiving the phone call. The blood pressure control rate among those who answered phone calls and who did not answer phone calls increased from 21.0% to 44.3% (P &lt; 0.001) and 22.8% to 48.8% (P &lt; 0.001), respectively. The blood pressure control rate at follow-up was significantly associated with phone calls (OR: 1.51, 95% CI: 1.34 - 1.71). The study demonstrates that follow up visits and telephone call intervention can improve patient retention in care and subsequently, blood pressure control among hypertensive patients attending urban private-sector clinics in India.

English

Despite the achievements of Anti-retroviral Treatment (ART) scale-up programmes for HIV/AIDS, retention remains a challenge. Achievements of the &ldquo;90-90-90&rdquo; HIV targets for the sustainable development goals hinges on adherence. Despite the importance of indefinite retention of patients in care, 33% of HIV patients in Cameroon are still lost-to-follow-up, thereby compromising scale-up initiatives. This study analyses data of patients on ART in Treatment Centres (TCs) and the associated loss-to-follow-up factors and proposes measures to address them. This research was a retrospective analysis of data from selected HIV/AIDS TCs. After obtaining consent, questionnaires were filled by participating TCs. Collected data were analysed using SPSS and figures were expressed as bar charts, and histograms. Five out of seven TCs participated, giving a participation rate of 71.4%. Of the 12,165 patients, 11,852 (97.4%) were adults (28.0% males and 69.4% females) while 313 (2.6%) were children. A total of 232 (1.9%) were lost-to-follow-up and 38 died within six to twelve months. Possible causes of loss-to-follow-up included poor treatment and adherence counselling, ignorance, stigmatisation, financial hardship and traditional and religious beliefs. All TCs reported transfer into and out of their centre, caused by distance, nature of job, and overcrowding. Concerns of attrition rates throughout the continuum of care from diagnosis to long-term retention are corroborated by other studies. Such attrition compromises gains from ART scale-up, leading to poorer health outcomes and wastage of limited resources. Therefore, instituting sustained counselling and education services, addressing social determinants and building on social support factors provide measures to improve retention Key words: Retention, anti-retroviral therapy, treatment, loss-to-follow-up.

Phone calls for improving blood pressure control among hypertensive patients attending private medical practitioners in India: Findings from Mumbai hypertension project.

Despite the availability of effective medication, blood pressure control rates are low, particularly in low‐ and middle‐income countries. Adherence to medication and follow‐up visits are important factors in blood pressure control. This study assessed the effectiveness of reminder telephone calls on follow‐up visits and blood pressure control among hypertensive patients as part of the Mumbai Hypertension Project. This project was initiated by PATH with the support from Resolve to Save Lives from January 2019 to February 2020. The study included hypertensive patients attending 164 private practices in Mumbai, India; practitioners screened all adults visiting their clinic during the project period. Among 13 184 hypertensive patients registered, the mean age was 53 years (SD = 12.38) and 52% were female. Among the 11 544 patients that provided phone numbers and gave consent for follow‐up calls, 9528 responded to phone calls at least once and 5250 patients followed up at least once. Of the 5250 patients, 82% visited the clinic for follow‐up visit within one month after receiving the phone call. The blood pressure control rate among those who answered phone calls and who did not answer phone calls increased from 23.6% to 48.8% (P <.001) and 21.0% to 44.3% (P <.001), respectively. The blood pressure control rate at follow‐up was significantly associated with phone calls (OR: 1.51, 95% CI: 1.34 ‐ 1.71). The study demonstrates that telephone call intervention and follow‐up visits can improve patient retention in care and, subsequently, blood pressure control among hypertensive patients attending urban private sector clinics in India.

Tracking: emergency method or health vigilance in the retention of patients living with HIV/AIDS?

There were 1.7 million HIV/AIDS-related deaths worldwide. The low retention of patients in care was a hindrance to their treatment. The objective of this study was to establish the epidemiological profile of patients, to implement “tracking” and to evaluate its effectiveness. This is a descriptive and analytical retrospective study of all patients living with HIV/AIDS enrolled from 2004 to 2012 by the non-governmental organization ACONDA-VSCI. It consisted of a series of phone calls and home visits. Results showed that 71% of the 51.703 patients enrolled were female with a sex-ratio (F/M) of 2.5. The average age of patients was 33±13 years. 47% of the patients enrolled had an unknown vital status in 2011 and only 42% of them had a telephone number. In addition, 11% of patients with unknown vital status were contacted and reintegrated into the care system. Multivariate regression analysis showed that the lack of awareness of status in patients was related to elevated CD4s, and having spent more than three years in a health center. On the other hand, being in a relationship and living in a rural area was a protective factor against the lack of knowledge of status. At the end of this study, it appears that the tracking method is an excellent method of combating the loss of sight of patients. However, it must be carried out routinely as a method of health vigilance and not a health emergency.

998. Understanding Retention in PrEP Care in the South: Insights from an Academic HIV Prevention Clinic

BackgroundDaily emtricitabine-tenofovir disoproxil fumarate has emerged as one of the most effective tools to prevent HIV transmission. However, it remains poorly utilized in the South. We report on PrEP retention in care and sexually transmitted infections (STIs) in a large academic PrEP clinic in Durham, North Carolina.MethodsWe conducted a retrospective chart review of patients in the Duke University PrEP Clinic from Jan. 1, 2015 through Oct. 15, 2019. Short-term retention in care was completion of a 3 month (mo) follow up as per CDC guidelines. Long-term retention was defined as completion of a 3 mo visit and an additional visit between 8 and 12 mo. Baseline STI was defined as a diagnosis at or within 1 year prior to initial PrEP visit. STI diagnosis while on PrEP was any subsequent diagnosis while retained in care. Odds ratios (OR) were generated using multivariable logistic regression. Kaplan-Meier curves were generated for retention in care and compared using the log rank test.ResultsA total of 255 patients attended at least one PrEP clinic encounter; 89% were men, 37% were Black, and 73% identified as men who have sex with men (MSM); 153 (60%) returned for at least one follow-up visit. Short and long term retention in care were met by 130/237 (55%) and 80/217 (37%) patients respectively. OR for retention are reported in Table 1. MSM are more likely to be retained in the short-term (OR 5.22 [95% confidence interval (CI) 1.57-17.32]). Self-referred patients were more likely to be retained in the long-term (OR 2.18 [95% CI 1.12-4.23]). Patients without insurance were less likely to attain long-term retention in care outcomes (OR 0.32 [95% CI 0.11-0.91]). STI diagnoses include 30 (12%) patients for a total of 42 unique infections at baseline and 44 (17%) for a total of 69 unique infections at follow up. Two new HIV diagnoses were made at first PrEP clinic encounter with no new diagnoses made at follow-up. Baseline STI was not associated with retention in care over time with disengagement defined as 6 mo post last visit (Figure 1).Table 1) Odds Ratios of Retention in Care at 3 and 12 Months Figure 1) Retention in Care for Patients with Baseline STI Diagnosis. ConclusionOur PrEP clinic shows a decline in patient retention over time. STIs were also prevalent, reinforcing that frequent STI testing and counseling should be part of each PrEP encounter. Further investigations into how to increase and improve PrEP utilization for HIV prevention are needed.Disclosures All Authors: No reported disclosures

Lower rates of ART initiation and decreased retention among ART-naïve patients who consume alcohol enrolling in HIV care and treatment programs in Kenya and Uganda.

Almost 13 million people are estimated to be on antiretroviral therapy in Eastern and Southern Africa, and their disease course and program effectiveness could be significantly affected by the concurrent use of alcohol. Screening for alcohol use may be important to assess the prevalence of alcohol consumption and its impact on patient and programmatic outcomes. As part of this observational study, data on patient characteristics and alcohol consumption were collected on a cohort of 765 adult patients enrolling in HIV care in East Africa. Alcohol consumption was assessed with the AUDIT questionnaire at enrollment. Subjects were classified as consuming any alcohol (AUDIT score >0), hazardous drinkers (AUDIT score ≥8) and hyper drinkers (AUDIT score ≥16). The effects of alcohol consumption on retention in care, death and delays in antiretroviral therapy (ART) initiation were assessed through competing risk (Fine & Gray) models. Of all study participants, 41.6% consumed alcohol, 26.7% were classified as hazardous drinkers, and 16.0% as hyper drinkers. Depending on alcohol consumption classification, men were 3-4 times more likely to consume alcohol compared to women. Hazardous drinkers (median age 32.8 years) and hyper drinkers (32.7 years) were slightly older compared to non-hazardous drinkers (30.7 years) and non-hyper drinkers (30.8 years), (p-values = 0.014 and 0.053 respectively). Median CD4 at enrollment was 330 cells/μl and 16% were classified World Health Organization (WHO) stage 3 or 4. There was no association between alcohol consumption and CD4 count or WHO stage at enrollment. Alcohol consumption was associated with significantly lower probability of ART initiation (adjusted sub-distribution hazard ratio aSHR = 0.77 between alcohol consumers versus non-consumers; p-value = 0.008), and higher patient non-retention in care (aSHR = 1.77, p-value = 0.023). Alcohol consumption is associated with significant delays in ART initiation and reduced retention in care for patients enrolling in HIV care and treatment programs in East Africa. Consequently, interventions that target alcohol consumption may have a significant impact on the HIV care cascade.