Retention and HIV Care
Can a 1-Hour Intervention Help?
The armamentarium of medications to treat HIV infection works well but only if patients engage in care and continue to be treated for the remainder of their lives.
For this reason, “retention in care” has been a focus for many HIV researchers. One stumbling block, however, is that many programs that successfully retain individuals with HIV in care consume considerable time and resources.
Researchers from the University of California at San Diego, the University of Michigan in Ann Arbor and the University of Connecticut looked at this issue against the backdrop of the fact that more than half those with HIV in the United States have difficulty remaining engaged with their care. This group of researchers has published a pilot study in AIDS Care that describes a 60-minute intervention to retention in care.
The program this group uses—60 Minutes for Health— is a practical, theory-based behavioral intervention designed to be delivered in a single session using few resources. It targets individuals with HIV who experienced a gap in care exceeding 6 months. For these reasons, 60 Minutes for Health could be advantageous in the busy clinic setting.
60 Minutes for Health employs a few principles to engage nonadherent patients:
- The program addresses substance use, depression, transportation, competing priorities, and the patient's feelings about HIV infection and possible stigmatization.
- The program also addresses participants’ misperceptions, attitudes and beliefs.
- A health educator works with participants through a semi-structured intervention using an illustrated workbook.
- The program leverages patients’ physical health priorities to improve care retention.
In this pilot study, the researchers randomly assigned patients to either the 60 Minutes for Health program or a diet/nutrition arm. Ultimately, 16 patients consented to participate in the study. Compared with controls, participants who engaged in 60 Minutes for Health had significantly better retention in the 12 months after the intervention, with 63% of intervention-treated patients remaining retained, as opposed to 25% of control group participants.
The authors noted that this is a small/pilot study, so it is difficult to extrapolate findings to a larger group. However, having demonstrated that this short intervention is feasible and cost-effective, this study lays the groundwork to try 60 Minutes for Health at other locations. The researchers proposed a larger study to assess its efficacy in busy clinics in many different settings.
Smith LR, Amico KR, Fisher JD, Cunningham CO. 60 Minutes for health: examining the feasibility and acceptability of a low-resource behavioral intervention designed to promote retention in HIV care. AIDS Care. 2017:1-12. doi: 10.1080/09540121.2017.1344184.