Retention in Care

 

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Sustained, regular HIV care, including initiating and maintaining antiretroviral therapy (ART), is vital to the overall health of HIV-infected patients and for prevention of HIV transmission.

Recent research shows that HIV-infected patients who received ongoing, regularly scheduled care had significantly lower viral loads, higher CD4 cell counts, and reduced morbidity and mortality than those who missed even one medical visit over a 2-year period. 1, 2 Other benefits of regular, ongoing HIV care included increased safer sexual behaviors, lower rates of progression to AIDS, decreased rates of hospitalization, and improved overall health. 2, 3, 4

Among the estimated 1.1 million people with HIV in the United States, 86% have received a diagnosis, 63% received HIV medical care in 2015, 49% were receiving continuous care, and 51% were virally suppressed. 5, 6

What Factors May Predict Patient Inconsistencies with Regular, Ongoing Care?

Findings show that patients who are younger (<25 years of age), are female, belong to a minority race or ethnicity, or are of lower socioeconomic status may be more likely to drop out of care or be inconsistent with care, along with those who lack health insurance, are medically insured via public health services, or have newly changed their insurance carrier.1, 3 Patients with drug or alcohol dependence,1, 3 as well as untreated depression, 6 may also cycle in and out of care.

What Barriers Do Patients Face to Remain In Care?

Barriers to ongoing care may arise from a patient’s personal or cultural beliefs, cognitive abilities, and health status, including comorbidities. Barriers also may be related to poor mental health or substance use, or structural issues such as lack of housing, job, transportation, or health insurance.

How Can HIV Care Providers Keep Patients Engaged in Care?

Talking with patients at regular visits allows HIV care providers to reinforce positive behaviors, uncover barriers to successful ongoing treatment, and facilitate access to services and resources as needs change over time. 2, 3, 4 A number of studies have shown that brief conversations engaging patients in care can improve outcomes 2, 3, 4

How Do Brief Conversations About Regular, Sustained Care Benefit HIV Care Providers?

Recent research demonstrates that brief conversations with patients at every office visit help build relationships that keep patients engaged in their own care over the long term.7 Ongoing care means increased survival rates and better clinical outcomes for patients.1, 2 The most effective discussions are short, direct, nonjudgmental, and supportive in tone.

A number of studies demonstrate that regular discussions about the importance of ongoing care present teachable moments during which HIV care providers can help motivate patients to continue with care and/or make positive changes to improve their care. 2, 3, 4 Successful teachable moments are those during which HIV care providers (1) help patients understand why keeping appointments and taking medications on time is important for their health, (2) identify and explore each patient’s specific barriers to ongoing care and help address them, (3) offer information needed to motivate patients toward a specific change or a resource for overcoming barriers, and (4) confirm each patient’s willingness to commit to keeping every appointment. 2, 3, 4

What Are Suggested Conversation Starters to Discuss Regular, Ongoing Care with Patients?

For new patients, HIV care providers can set the stage for ongoing care with the following conversation starters:

  • “It’s important that you come to your medical appointments regularly so I can monitor your progress and help you stay healthy. Let’s talk about what that means.”
  • “I know it can be difficult to keep all your appointments, but it’s very important. What can we do to make sure you keep your next appointment?”
  • “I’m looking forward to seeing you on a regular basis.”

For patients who regularly attend appointments, HIV care providers have the opportunity to personalize discussions to keep patients motivated:

  • “You’re looking well today, and I’m pleased that you’ve been coming in so regularly.”
  • “Thank you for doing such a good job of keeping your appointments. It makes it easier for us to work together to keep your HIV virus under control and keep you healthy.”

For patients who keep appointments inconsistently, HIV care providers can convey a supportive tone:

  • “People with HIV do better overall when they come to their appointments on a regular basis. How can we make this happen for you?”
  • “I need your help to keep you healthy. When you come to your appointments to see me, we can work together to make you as healthy as possible.”
  • “Let’s talk about what has been keeping you from coming to see me.”