Retention in HIV care: The role of outreach interventions

BACKGROUND Receipt of regular HIV medical care is essential for maintaining health. HRSA's Outreach Initiative was implemented in 9 cities from 2003-2006 to promote engagement and retention of underserved populations in HIV medical care and reduce health disparities. MEHODS 1133 HIV positive individuals considered at risk for non-engagement in care were enrolled in interventions and participated in a longitudinal study. Client interviews collected data on socio-demographic characteristics, service utilization, support service needs, health-related quality of life and barriers to care. Medical visits and lab values were collected through chart review and intervention contacts were collected through encounter forms. Multivariate analyses identified factors associated with retention in care. RESULTS Over 12 months, retention in HIV care was significantly associated with discontinued drug use, a decrease in structural barriers and unmet needs, and the absence of negative health beliefs. Participants with 9 or more intervention contacts in the initial 3 months were more likely to be retained in care. Accompaniment to medical visits was associated with care retention, and relationships with health care providers improved. Significant improvements in mental health status and an increase in percent of participants with undetectable viral loads resulted. CONCLUSIONS Outreach interventions can be effective in promoting engagement and retention in HIV medical care. By addressing HIV knowledge and beliefs, reducing unmet needs and structural barriers to care, and helping individuals in interactions with health care providers, programs can help underserved populations maintain connection with the health care system, thereby improving both their health and quality of life.