Table 3.
Details of reviewed studies assessing strategies to improve retention in HIV care
| First author (year) | Study dates | Location | Sample size (population) |
Design | Intervention | Primary outcome | Results |
|---|---|---|---|---|---|---|---|
| Highly resourced settings | |||||||
| Andersen [36] (2007) |
Not reported | Detroit, MI | 61 (women) | 2-arm, prospective, pre-post | Nurse-based counseling and transportation assistance vs. transport alone | No missed appointments in 6 months | Transport plus: 10% pre 58% post Transport only: 21% pre vs. 61%post (at a 12-month follow-up) |
| Bocour [23] (2013) |
2007–2011 | New York City | 10,095 (newly diagnosed) | 2 groups, retrospective | Home-based assessment of patient’s knowledge of treatment plan by Field Services Unit (FSU) | Two CD4 counts separated by at least 90 days in a 12-month period | 84 vs. 87% (non-FSU vs. FSU) p<0.001 |
| Bradford [35] (2007) |
Oct 2003–Jun 2006 | Boston, Portland, Seattle, Washington, DC | 437 | Single-arm, prospective, pre-post | Patient navigation by trained staff | 2 or more clinic appointments in a 6-month period | 64% pre-intervention 79% 12 months post intervention |
| Cabral [40] (2007) |
2004–2006 | 10 US cities | 773 | Single-arm, retrospective, pre-post | Appointment reminders, transportation and housing assistance, and case management | Gap of 4 months or more for scheduled clinic visits | HR 0.45 (95% CI 0.26–0.78) |
| Davila [41] (2012) |
Jan 2002–Aug 2008 | Houston | 174 (Latino and Afiican-American youth) | 3 groups, retrospective | Co-location of youth-based services vs. youth-based services and educational support vs. no services | 3 or more quarters with at least 1 visit in a 12-month period | Referent: Youth services No youth services: OR 0.42 (95% CI 0.17–1.43) Youth services plus: OR 1.18 (95%CI 0.55–2.53) |
| Enriquez [42] (2007) |
Mar 2005–Mar 2007 | Kansas City | 43 (Latinos) | 1 group, retrospective, pre-post | Bilingual peer educators and case managers | Number of visits with HIV provider per year | Mean: 2.81 (pre) vs. 5.30 (post) |
| Gardner [20] (2005) |
Mar 2001–May 2002 | Atlanta, Baltimore, Miami, Los Angeles | 273 (newly diagnosed) | 2-arm, randomized | Strength-based case management sessions | 2 or more clinic visits in a 12-month period | 64 vs. 49% (intervention vs. control) RR 1.41 p<0.001 |
| Gardner [43•] (2012) |
May 2008–May 2010 | Baltimore; Boston; Birmingham, AL; Brooklyn, NY; Bronx, NY; Houston; Miami | 8535 | Single population, cross-sectional, pre-post | Provider-based messages, clinic posters, and brochures promoting care engagement | 2 consecutive HIV care visits separated by 90 days in a 12-month period | 48.6 vs. 52.2% (pre vs. post) |
| Gardner [44•] (2014) |
2010–2011 | Boston, Miami; Baltimore; Birmingham, AL; Houston; New York City | 1838 | 3-arm, randomized | Periodic face-to-face contact and periodic phone calls from interventionist (EC) vs. EC and strength-based skill building sessions vs. standard of care (SOC) | 2 or more visits separated by >90 days in a 12-month period | SOC 45.6% EC only 55.6% EC + skills 55.8% |
| Hightow-Weidman [34] (2011) |
Jun 2006–Aug 2009 | Chapel Hill, NC | 89 (Latino and African-American MSM) | 2 groups, retrospective | Strength-based case management, appointment coordination, and co-location of services | 3 or more HIV care visits in the first 12 months after enrollment | 80 vs. 67% (intervention vs. control) |
| Naar-King [38] (2009) |
Mar 2006 | Detroit | 87 (adolescents and young adults) | 2-arm, randomized | Motivational interviewing by case managers | Gaps in scheduled appointments over a 12-month period | Mean: 2.76 vs. 1.33 (pre vs. post) |
| Purcell [45] (2007) |
Aug 2001–March 2005 | Miami, New York City, San Francisco | 795 (injection drug users) | 2-arm, randomized | Peer 1-on-l vs. video-based mentoring sessions | 2 or more clinic appointments in a 6-month period | 69 vs. 64% (peer vs. video) at 12 months OR 1.14 (95% CI 0.82–1.58) |
| Willis [37] (2013) |
Oct 2009–Sep 2010 | Washington, DC | 5631 | Observational | On-site case management vs. standard clinic | 2 or more clinic visits separated by 90 days in a 12-month period | OR 4.13 (95% CI 1.93–8.85) |
| Wohl [39] (2011) |
Apr 2006–Apr 2009 | Los Angeles | 61 (Latino and African-American MSM) | 1 group, retrospective, post | Case management with strength-based counseling | 2 or more clinic appointments in a 6-month period | 70% at 6 months |
| Resource-poor settings | |||||||
| Alamo [46] (2012) | Oct 2008–June 2009 | Uganda | 6500 encounters | 1 group, prospective pre-post | Implementation of electronic medical record | LTFU: Absent 3 or more months after last scheduled appointment |
LTFU: 10.9 to 4.8% (pre vs. post) |
| Balcha [47] (2010) | Feb 2007–Feb 2009 | Ethiopia | 1709 | 2 groups, retrospective | Decentralization: Health center-based vs. hospital-based care |
LTFU: Absent 3 or more months after last scheduled appointment |
10% (health center-based) vs. 23% (hospital-based) |
| Bedelu [48] (2007) | Jan 2004–Jul 2006 | South Africa | 1025 | Prospective, observational | Decentralization: Health center-based vs. hospital-based care | LTFU: Not defined |
2% (clinic-based) vs. 19% (hospital-based) at 1 year |
| Braitstein [49] (2012) |
Mar 2007–Mar 2009 | Kenya | 4958 | 2 groups, retrospective | Express care for high-risk patients vs. SOC | LTFU: Absent 3 or more months after last scheduled appointment |
Adjusted HR 0.59 (95% CI 0.45–0.77) |
| Brennan [50•] (2011) |
Feb 2008–Jan 2009 | South Afiica | 2848 | 2-arm, prospective, matched | Decentralization/task-shifting: Down referral to health center (nurse) vs. hospital-based (physician) care |
LTFU: Absent 3 or more months after last scheduled appointment |
1.7% in down referral vs. 5.1% in hospital-based Combined attrition: RR 0.27 (95% CI 0.15–0.49) at 1 year |
| Chan [51] (2010) | October 2004–December 2008 | Malawi | 8093 | 2 groups, retrospective | Decentralization: Health center-based (rural) vs. hospital-based (urban) care |
LTFU: Absent 3 or more months after last scheduled appointment |
Rural vs. urban: Adjusted OR 0.48 (95% CI 0.40–0.58) |
| Decroo [52] (2010) | Feb 2008–May 2010 | Mozambique | 1384 | 1 group, retrospective | Self-forming groups for peer ART adherence support | Retention in care: No death or LTFU (absent for 3 or more months from care) |
97.5% retention rate at 13 months |
| Fatti [53] (2010) | 2004–2007 | South Afiica | 29,203 | 3 groups, retrospective | Decentralization: Regional hospital vs. district hospital vs. health center-based care (PHC) |
LTFU: Absent 3 or more months after last scheduled appointment |
LTFU (PHC referent) Adjusted HR: Regional hospital 2.19 (95% CI 1.94–2.47) District hospital 1.60 (95% CI 1.30–1.99), |
| Fatti [54] (2012) | 2004–2010 | South Afiica | 66,953 | 2 groups, prospective, observational | Protocolized home visits by patient advocates (PA) vs. standard of care | Attrition: Dead or absent from clinic for 180 days or more |
Adjusted HR 0.65 (95% CI 0.59–0.72) at a median of 14.8 months |
| Franke [55•] (2013) | June 2007–Aug 2008 | Rwanda | 610 | 2 groups, prospective, observational | Daily visits by community health workers (CHW), monthly food rations, accompanied to clinic by CHWs, and financial support vs. SOC | LTFU: Absent 2 or more months after last scheduled appointment |
Adjusted HR 0.17 (95% CI 0.09–0.35) at 1 year |
| Greig [56] (2012) | 2003–2007 | 9 SSA countries | 15,403 | Retrospective, observational | Decentralization: Integrated-based (local primary care) vs. vertical (HIV-only tertiary center) care |
LTFU: Absent 2 or more months after last scheduled appointment |
Integrated vs. vertical: HR 0.71 (95% CI 0.61–0.83) |
| Humphreys [57] (2010) |
Jan–Nov 2007 | Swaziland | 582 | 2-arm, prospective, non-randomized | Decentralization/task-shifting | LTFU: Absent 3 or more months after last scheduled appointment |
2.4 (nurse care) vs. 1.3 (standard care), RR 1.85 (95% CI 0.41–8.34) at 6 months |
| Jaffar/Amuron [58, 59•] (2009) | Feb 2005–Jan 2009 | Uganda | 1459 | 2-arm, cluster-randomized equivalence | Monthly home-based vs. standard clinic-based care | LTFU: Not defined |
1 vs. 2% (home vs. clinic) at median of 28 months of follow-up |
| Kohler [60] (2011) | 2005–2007 | Kenya | 1024 (ART-ineligible) | Prospective, observational | Received cotrimoxazole prophylaxis at diagnosis vs. SOC | LTFU: Absent 30 days or more months after last scheduled appointment |
Adjusted HR 2.64 (95% CI 1.95–3.57) at 1 year |
| Kimutsor [61] (2011) |
Mar–Sep 2010 | Uganda | 174 | 2-arm, randomized | Patient-selected treatment supporters (DOT, appointment accompaniment, group education) vs. SOC | Missed visits | 1 (TS group) vs. 7 (SOC) at 28 weeks |
| Lambdin [62] (2013) |
Jan 2006–Jan 2008 | Mozambique | 11,775 | 2 groups, retrospective, observational | Decentralization: Integrated-based (local primary care) care vs. vertical-based (HIV-only tertiary center) care |
LTFU: Absent 2 or more months after last scheduled appointment |
Integrated vs. vertical: HR 1.75 (95% CI 1.04–2.94) |
| Massaquoi [63] (2009) |
Jun 2006–June 2007 | Malawi | 4074 | 2 groups, retrospective | Decentralization: Hospital-based vs. health center-based care |
In care and alive on ART | 85% in both hospital and health center-based groups |
| McGuire [64] (2012) |
Aug 2001–Dec 2008 | Malawi | 15,412 | 2 groups, retrospective | Decentralization: Health center-based (decentralized) vs. hospital-based care (centralized) |
Attrition: Death or LTFU (absent for 2 or more months after last scheduled appointment) |
Attrition rates at 2 years: 9.9 per 100 person years (decentralized) vs. 20.8 per 100 person years (centralized) |
| Odale [65] (2012) | 2007–2010 | Nigeria | 6408 | 2 groups, retrospective | Decentralization: Secondary vs. tertiary hospital-based care |
Attrition: Death or LTFU (absent for 3 or more months after last scheduled appointment) |
10.7% at secondary hospitals and 19.6% tertiary hospitals (p<0.001) at 24 months |
| Same [66•] (2010) | Feb 2005–Jan 2009 | South Africa | 812 | 2-arm, randomized, non-inferiority | Task-shifting: Nurse vs. physician-based HIV care |
Missed 3 consecutive study visits (LTFU) | 4% in nurse group and 15.4% in physician group (HR 1.42, 95% CI 0.63–3.20) at 120 weeks |
| Selke [67] (2010) | Mar 2006–Apr 2008 | Kenya | 208 | 2-arm, randomized | Monthly home visits + clinic visits every 3 months vs. monthly clinic visits (SOC) | LTFU (definition not reported) | 5.2 vs. 4.5% (intervention vs. control), p>0.5 at 24 months |
| Shumbusho [68] (2009) |
Sep 2005–Mar 2008 | Rwanda | 1076 | 1 group, retrospective | Task-shifting: Nurse-based care |
LTFU: Absent 3 or more months after last scheduled appointment |
91% at 24 months |
| Torpey [69] (2008) | Mar–Apr 2007 | Zambia | 3903 (pre), 4972 (post) | 1 group, pre-post | Adherence support by community-based volunteers | LTFU: Missing 3 consecutive monthly pharmacy appointments |
15% (pre) vs. 0% (post) at 12 months |
CI confidence interval, HR hazard ratio, LTFU lost to follow up, OR odds ratio, RR risk ratio, SOC standard of care