Keith Henry, MD reviewing Rebeiro PF et al. J Acquir Immune Defic Syndr 2017 Jun 09.

Contacting HIV-infected persons within 8 days of a missed appointment doubled the return to care rate in a retrospective study of 108,000 patients in Kenya.

Loss to care continues to be a major obstacle to achieving improved clinical outcomes and decreased HIV transmission risk within a defined jurisdiction. To evaluate factors associated with improved return to care rates after a missed appointment, investigators have conducted a retrospective study involving 108,221 HIV-positive persons seen between 2001 and 2011 within a care system comprising 19 clinics in Kenya.

Patients missing appointments were contacted by trained staff and received counseling that encouraged return to care. Among the 34,522 (32%) who missed an appointment and were considered lost to clinic, 44.4% had a documented gap in care, 8.0% were deceased, and 2.4% transferred to another clinic. Of the remaining 45.2%, most (56.2%) later returned to clinic, confirming a gap in care.

Of those considered lost to clinic, 68% were female, and at the time of missed appointment, the median age was 35.9 years and the median CD4 count was 255 cells/mm3. Adjusted cause-specific hazard ratios showed that early outreach (≤8 vs. >8 days from missed appointment) doubled the return to care rate. Return to care rates were lower with later outreach times and higher enrollment CD4 counts. Return to care rates were higher for females and with ART use, older age, and HIV disclosure.

Citation(s):

Rebeiro PF et al. An observational study of the effect of patient outreach on return to care: The earlier the better. J Acquir Immune Defic Syndr 2017 Jun 09; [e-pub].

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