411. A simple strategy to classify and reengage HIV-infected patients poorly retained in care via personal outreach by a social worker
Session: Poster Abstract Session: HIV Engagement in Care and the Care Cascade
Thursday, October 8, 2015
Room: Poster Hall
Posters
  • IDSA Poster Reengagement FINAL JPEG.jpg (842.4 kB)
  • Background: Many patients are poorly retained in care, and our purpose was to classify and reengage these patients. We piloted a program for intensive outreach services by creating a licensed professional counselor (LPC) position focused on reengagement and retention in care.

    Methods: We identified patients who attended our multidisciplinary clinic in the past five years and did not meet the HRSA definition of retention in care in 2014 (2 visits to an HIV provider 90 days apart).  We determined if the patients had transferred care, died, been incarcerated, or fallen out of care.   The intervention began by conducting a search for patients who had fallen out of care and, if possible, calling them to schedule a visit.  If unsuccessful, a letter was then mailed.  If unsuccessful, as time allowed, a home visit was made. 

    Results: For 2014, 233 patients were not retained in care.  Of them 77 (33%) transferred care, 14 (6%) died, 14 (6%) were incarcerated, and 128 (55%) had fallen out of care.  Patients who had fallen out of care were significantly more likely to be female, African-American, have lower CD4 counts and higher viral loads than patients who transferred care (Table 1).  Intervention occurred in most patients [127 (99%)]. As a result, 39 (30%) patients attended a visit, 5 (4%) scheduled and missed a visit, and 13 (10%) scheduled a future visit, showing a positive outcome in 57 (45%) by April 30, 2015 (Table 2).

    Conclusion: Many of the patients identified as poorly retained had not fallen out of care.  Patients who had fallen out of care were significantly different from patients who transferred care.  Personal contact with an LPC was an effective intervention in patients who had fallen out of care.

    Table 1

    Fallen out of Care

    (n=128)

    Transferred Care

    (n=77)

    P-value

    Age (years)

    42

    43

    NS

    Male

    92 (72%)

    66 (86%)

    0.03

    African-American

    101 (79%)

    41 (53%)

    0.00

    Hispanic

    9(7%)

    2(3%)

    NS

    Insurance

    NS

         Medicaid

    26 (20%)

    9 (12%)

         Ryan White

    63 (49%)

    41 (53%)

         Medicare

    21 (16%)

    10 (13%)

         Private

    16 (13%)

    17 (22%)

    CD4 Count (mean)

    415

    516

    0.02

    Viral Load (median)

    275

    0

    0.05

    Viral Load (mean)

    53,341

    16,613

    0.05

    Table 2

    Scheduled a Visit

    Attended a Visit

    Future Visit  

    Total with positive outcome

    Phone  (n=25)

    2 (8%)

    14 (56%)

    8 (32%)

    24(96%)

    Phone and Letter (n=88)

    3 (3%)

    23 (26%)

    4 (5%)

    30 (34%)

    Phone, Letter, and Home Visit (n=14)

    0 (0%)

    2 (14%)

    1 (7%)

    3 (21%)


    Madelyne Bean, PharmD1, Linda Scott, LPC2, J. Michael Kilby, MD3 and Lauren Richey, MD, MPH1, (1)Infectious Diseases, Medical University of South Carolina, Charleston, SC, (2)Medical University of South Carolina, Charleston, SC, (3)Infectious Diseases/Medicine, Medical University of South Carolina, Charleston, SC

    Disclosures:

    M. Bean, None

    L. Scott, None

    J. M. Kilby, None

    L. Richey, None

    Findings in the abstracts are embargoed until 12:01 a.m. PDT, Wednesday Oct. 7th with the exception of research findings presented at the IDWeek press conferences.