Linking and retaining HIV patients in care: The importance of provider attitudes and behaviors

Retention in HIV treatment may reduce morbidity and mortality, as well as slow the epidemic. Myriad barriers to retention include stigma, homophobia, structural barriers, transportation, and insurance. The purpose of this study was to evaluate patient perceptions of provider attitudes among HIV-infected persons within a state-wide public hospital system in Louisiana. A convenience sample of patients attending HIV clinics throughout the state participated in an anonymous interview. Factors associated with negative perceptions of care were evaluated in conjunction with a validated stigma measure. Factors associated with having a delayed entry into or break in care were evaluated in conjunction with perceived stigma. Between 2/1/09 and 7/31/11, 479 participants were interviewed and had sufficient data available, of whom 53.4% were male, 79.3% were African American, and 29.4% reported a break or delayed entry into HIV care of \u3e1 year. A break in care was associated with perceiving that the doctor or health professionals do not listen carefully most or all of the time (p\u3c0.01), having an elevated stigma score (p\u3c0.05), and indicating that providers dislike caring for HIV-infected people (p\u3c0.01). Women were more likely to have an elevated stigma score than men (p\u3c0.01), as were participants over 30 (p\u3c0.01); those with a gay/bisexual orientation (p\u3c0.05) were less likely to have an elevated stigma score. Those with a break in care were less likely to have Medicaid (p\u3c0.05). Providers play a key role in the retention of HIV-infected persons in care and are critical to improving outcomes and slowing the epidemic. Development of novel approaches to reduce stigma are imperative in improving retention

Second Wind: The Impact of Hurricane Gustav on Children and Families Who Survived Katrina

The category 2 Hurricane Gustav made landfall on the Louisiana Coast on Sept. 1, 2008, nearly three years to the day after Hurricane Katrina, resulting in an evacuation of approximately 2 million people and considerable property damage. Although it did not match the intensity or consequence of Hurricane Katrina, the experience of anticipating and responding to Hurricane Gustav had the potential to trigger emotional and physical consequences among a population previously traumatized or displaced by Hurricane Katrina. Gustav also had the potential to exert a considerable impact upon the overall economic, social, and emotional recovery of these populations. The Gulf Coast Child and Family Health Study (G-CAFH), a randomly-sampled post-Katrina longitudinal cohort study of 1,079 displaced and impacted households in Louisiana and Mississippi, was uniquely positioned to examine the evolving impact of Gustav upon a previously traumatized population. G-CAFH researchers were in the final stages of the third round of interviews with the study group when Hurricane Gustav struck, thus allowing for comparable pre- and post-event data for approximately 700 respondent households. Further information on the study, including previous reports and peer-reviewed research articles, may be found at www.gcafh.org. In particular, the research team was interested in the following issues: Evacuation: People's response to the event itself -- did they evacuate, and if so, where and how did they evacuate? How did people decide whether to evacuate or not? For those who did, what was the economic impact of the evacuation? Recovery Impact: What was the impact on post-Katrina recovery amongst this group, particularly since Hurricane Gustav may have set some people even further back in their efforts to recover their homes and their lives? Psychological Impact: What was the emotional impact on adults and children: among adults, did Hurricane Gustav trigger Katrina-related post-traumatic stress disorder symptoms? Among children, did Hurricane Gustav lead to newly experienced behavioral or emotional problems? Health Effects: What were the health consequences of Hurricane Gustav on children, particularly those who needed access to medications and medical care? Within three weeks of Hurricane Gustav, the G-CAFH field team had reassembled after their own evacuation and begun re-contacting the 718 respondents whom they had recently interviewed as part of the third round of the study. Of these 718 respondents, 528 were located and interviewed (a 73.5% retention rate). Respondents received a $20 gift card for participating in this study supplement, which had received approval by the Columbia University Medical Center Institutional Review Board

Structural factors and best practices in implementing a linkage to HIV care program using the ARTAS model

<p>Abstract</p> <p>Background</p> <p>Implementation of linkage to HIV care programs in the U.S. is poorly described in the literature despite the central role of these programs in delivering clients from HIV testing facilities to clinical care sites. Models demonstrating success in linking clients to HIV care from testing locations that do not have co-located medical care are especially needed.</p> <p>Methods</p> <p>Data from the Antiretroviral Treatment Access Studies-II project ('ARTAS-II') as well as site visit and project director reports were used to describe structural factors and best practices found in successful linkage to care programs. Successful programs were able to identify recently diagnosed HIV-positive persons and ensure that a high percentage of persons attended an initial HIV primary care provider visit within six months of enrolling in the linkage program.</p> <p>Results</p> <p>Eight categories of best practices are described, supplemented by examples from 5 of 10 ARTAS-II sites. These five sites highlighted in the best practices enrolled a total of 352 HIV+ clients and averaged 85% linked to care after six months. The other five grantees enrolled 274 clients and averaged 72% linked to care after six months. Sites with co-located HIV primary medical care services had higher linkage to care rates than non-co-located sites (87% vs. 73%). Five grantees continued linkage to care activities in some capacity after project funding ended.</p> <p>Conclusions</p> <p>With the push to expand HIV testing in all U.S. communities, implementation and evaluation of linkage to care programs is needed to maximize the benefits of expanded HIV testing efforts</p

Estimating the Return of Persons Living With HIV/AIDS to New Orleans: Methods for Conducting Disease Surveillance in the Wake of a Natural Disaster

Hurricane Katrina disrupted HIV/AIDS surveillance by invalidating the New Orleans, La, surveillance and population data on persons living with HIV/AIDS. We describes 2 methods—population return and HIV surveillance data—to estimate the return of the infected population to New Orleans. It is estimated that 58% to 64% of 7068 persons living with HIV/AIDS returned by summer 2006. Although developed for HIV planning, these methods could be used with other disease surveillance programs

"Closing the Loop" Developing State-Level Data Sharing Interventions to Promote Optimum Outcomes Along the HIV Continuum of Care.

This manuscript describes the experiences of three state departments of health (SDoH) that successfully launched data sharing interventions involving surveillance and/or patient data collected in clinics to improve care outcomes among people living with HIV. We examined 58 key informant interviews, gathered at two time points, to describe the development and implementation of data sharing interventions. We identified three common themes across states' experiences: creating standard practices, fostering interoperability, and negotiating the policy environment. Projects were successful when state teams adapted to changing circumstances and were committed to a consistent communication process. Once implemented, the interventions streamlined processes to promote linkage and retention in care among low-income populations living with HIV. Despite using routinely collected data, key informants emphasized the labor-intensive process to develop and sustain the interventions. Lessons learned from these three state experiences can help inform best practices for other SDoH that are considering launching similar interventions