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in+care Newsletter | July 2012

Issue 9 


National Campaign to Improve Retention in HIV Care
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In This Issue
Upcoming Events
Using Technology to Contact Patients
Seeking Presenters!
Provider Spotlight
Journal Spotlight


until the next data submission deadline

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Data - National Averages*

(as of 7/17/12)


Gap Measure
(n = 162 sites, 103,332 patients)
Visit Frequency Measure
(n = 151 sites, 82,756 patients)
New Patient Measure
(n = 160 sites, 6,725 patients)
Viral Load Suppression
(n = 163 sites, 124,700 patients)
*data not unduplicated
Quick Links

Campaign Headquarters

National Quality Center (NQC)

New York State Department of Health AIDS Institute


90 Church Street, 13th floor
New York, NY 10007


Work: 212-417-4730
Fax: 212-417-4684


Upcoming Events 


Happy July! I cannot believe that the in+care Campaign has been humming along for 8 months, but I am inspired by all the wonderful work taking place. We have more than 400 distinct agencies participating in the Campaign in some capacity, representing many Ryan White grantees nationwide. Almost half of the agencies enrolled in the Campaign have submitted performance data into our Campaign database. More than 30% of the agencies enrolled in the Campaign have shared retention improvement strategies with us. In addition, we have an active coaching program (see the website for a full list of coaches by region) and we have 44 Local Quality Champions convening meetings on retention in 25 distinct regions/localities. We continue to offer cutting edge webinar programs on issues critical to understanding what more we can do to improve our patient retention in HIV care. Finally, we have nearly 500 partners in+care participating in our private Facebook community online.
Impressive stuff, indeed, but this is no time to rest! After all, summer is about turning up the heat and that is exactly what we are doing at the in+care Campaign. We are preparing new ways to review our performance data, identifying new ways to engage you as participants in our webinar programs, and finding new ways to disseminate the wonderful retention improvement strategies you are all working so hard to implement. 
The in+care Campaign staff is excited to see what the next 8 months holds and we look forward to continuing to work with all the fantastic teams that have joined us from around the country!
Upcoming Events

+ in+care Campaign Office Hours

Mondays and Wednesdays 4pm-5pm ET 

Office Hours allow in+care Campaign participants to directly communicate with NQC staff and consultants. Callers can ask general questions, request technical assistance or engage in dialogue about the Campaign. Upcoming discussion topics include:

  • Monday, July 23 - open format; no scheduled topic
  • Wednesday, July 25 - retention and substance abuse
  • Monday, July 30 - open format; no scheduled topic 

Dial-in#: 866.394.2346

Participant Code: 418 257 6142 #



+ in+care Campaign Webinar | Substance Abuse and Retention

Tuesday, July 31, 2012 4pm ET

Agenda: Substance Abuse and retaining patients in HIV care - Chinazo Cunningham, MD of the Montefiore Medical Center will walk participants through issues important to consider when serving patients struggling with substance abuse. If you have specific questions you would like answered in this program, please email them to Michael@nationalqualitycenter.org in advance of the program.


Dial-in#: 866.394.2346
Participant Code: 397 154 6368 #
+ Next Campaign Performance Data Submission
August 1, 2012
+ Next Improvement Update Form Submission
August 15, 2012
Keep up-to-date with the latest in+care events through our webpage: http://incarecampaign.org/index.cfm/75283
Using Technology to Contact Patients

As many of you know, our May 31 Campaign webinar focused on retaining youth in HIV care. During this webinar program, Campaign staff identified the need to examine the ways technology is used to contact patients (texting, social media, digital health applications, and personal health records). In response to this need, the in+care Campaign devoted an Office Hours session on July 9 to discuss what a model policy and procedure for the use of technology to contact patients would entail. You can find a recording of our conversation here within the Additional Resources folder.


Campaign staff is conducting additional research into how teams nationwide are currently using technology to interact with their patients. Tell us how you use technology at your agency for these purposes (michael@nationalqualitycenter.org)! If you have specific questions around the use of technology to contact patients, do not hesitate to send those as well! Based on existing resources and your feedback, the in+care Campaign will work with its partners to develop a listing of things to consider when drafting policies on the use of technology to contact patients for our next steps!

Seeking Presenters for August Campaign Webinar
Are you an expert on identifying patients who are at risk of falling out of care? If so, we would love to discuss the possibility of you joining us as a peer success story presenter for our August in+care Campaign webinar. Please email Michael at michael@nationalqualitycenter.org for more details!
Provider Spotlight - Primary Health Care, Inc.

Partnership, collaboration, and communication are the core elements of the retention and re-engagement project, Accessing Care Together (ACT), developed by Primary Health Care, Inc. (PHC) and the AIDS Project of Central Iowa (APCI). As a Ryan White HIV/AIDS Program Part C grantee located in Des Moines, PHC has always worked closely with APCI, a Ryan White Part B grantee, sharing information and connecting clients with the State's ADAP Program. The ACT project, which is in the pilot phase, enables the two organizations to share information in a more systematic and formalized way than ever before. The project will also have a strong consumer involvement component, including the creation of a Consumer Advisory Board.


The ACT Re-Engagement Specialist is a shared position between both programs. This position involves finding clients that have no evidence of medical care for more than one year. The Re-Engagement Specialist helps to improve communication and navigate confidentiality barriers between PHC and APCI.


Identifying clients that are truly lost-to-care (no evidence of medical care in 12 or more months) is a joint effort and is accomplished through multiple steps. These include:


1. Both PHC and APCI review all clients in CAREWare and identify those clients no longer engaged in medical care. The last case note from CAREWare is added to the client's information.

2. The lists are sent to the Iowa Department of Public Health's Surveillance Office for further investigation to categorize each client's engagement status (deceased, moved, incarcerated, in care at a different medical provider, or lost-to-care).

3. The lists are sent back to the respective programs and referrals are made to the Re-Engagement Specialist for those clients identified as lost-to-care by the Surveillance Office.


As part of the ACT project's referral process, a case conference occurs between the Part B Case Manager, Part C Nurse Manager, and the Re-Engagement Specialist. Providers share information about the client including: last known address/phone number, emergency contact, and any additional information that might help the Re-Engagement Specialist find the lost-to-care client. The Re-Engagement Specialist then goes out into the field and attempts to contact the client via phone, letter, or face-to-face contact. All contacts, outreach services and case notes are tracked in CAREWare for clients referred by APCI and in PHC's electronic medical record for their clients. Once the client is located the Re-Engagement Specialist works with them for 3 to 6 months identifying reasons why the client dropped out of care, helping to remove these barriers, and supporting the client's return to medical care.


Currently, the initial lost-to-care list is being analyzed by the Surveillance Office. Until the list is returned to PHC and APCI, the Re-Engagement Specialist is working with internal referrals for clients that have missed multiple appointments or those that PHC is unable to contact due to returned mail or disconnected phones. While still in the early stages of the pilot, the first internal referral client came in for a medical appointment last week!

Journal Spotlight - Mugavero, Lin, et al.

Mugavero MJ, Lin HY, Willig JH, et al. Missed Visits and Mortality among Patients Establishing Initial Outpatient HIV Treatment. Clin Infect Dis. 2009; 48:248-56.


In this article Mugavero et al. determine that retention in HIV care is an independent predictor of survival; and mortality rates are significantly lower among patients seen 3 or 4 times per year versus once or twice annually.  


The authors used a retrospective analysis nested within a prospective HIV clinical cohort study evaluating 543 patients initially starting HIV medical care between January 2000 and December 31, 2005 at the University of Alabama Birmingham. The authors sought to determine the relationship between missed visits in the first year of care and long-term survival. Patients were categorized into 2 groups - those that did not miss any visits and those that missed visits during their first year of HIV care. Sixty percent of study participants (n=325) missed a visit within the first year of HIV care, whereas 40% (n=218) attended all scheduled visits in the first year of care.


Factors statistically associated with missed visits within the first year of HIV care included:

  • younger age
  • black race
  • patients with public health insurance.


Factors associated with long-term survival involved:

  • missing at least one visit within the first year of HIV care
  • older patients
  • patients with public health insurance
  • baseline CD4 <200 cells/mm3.


For those patients that missed > 2 visits, survival factors were similar to those above.


Mugavero et al. found that mortality rates were more than 2 times higher for those that missed appointments in the first year, as compared to those patients that did not miss any visits in their first year of HIV care (2.3 vs. 1.0 deaths per 100 patient-years of follow-up).


Results from this study can be applied to clinic settings in helping to identify a priority population in which to focus retention efforts. Missed visits during the first year of HIV care acts as a signal for patients at risk for worse health outcomes.

Connect. With patients.
Collaborate. With a community of learners.
Change. The course of HIV. 

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