Partners in+care is the part of the in+care Campaign that is engaging People living with HIV and those who care about them in this important national dialogue. Specifically, Partners in+care has two goals:

1. What do I do to stay in care?
2. How do I help my friends, family and clients stay in care?

Partners in+care has custom created consumer-driven webinars focusing on the consumer perspective on issues related to retention in care. There is also a private Facebook community where consumers and those care for them can come together to discuss issues critical to staying in care.

Learn more about Partners in+care by clicking on this link! The Partners page includes a toolkit containing useful educational materials and other resources we can use to discuss the importance of staying in care with people with HIV. If you are a direct service provider and have consumer champions who want to be involved, ask them to email Michael@nationalqualitycenter.org for details! All are welcome!

Whitman-Walker Health is a non-profit community health center in the Washington, D.C. metropolitan area with a special expertise in HIV health care and Lesbian, Gay, Bisexual, and Transgender health care. Founded as an affirming health center for the gay and lesbian community in 1978, Whitman-Walker was one of the first responders to the HIVepidemic in Washington, D.C. and became a leader in HIVeducation, prevention, diagnosis and treatment. In recent years, Whitman-Walker has expanded its services to include primary health care services for the entire community regardless of HIV status, sexual orientation or gender identity. Whitman-Walker Health provides a number of health care services to the D.C. metro area through its two locations, including primary medical care, HIVprimary care, dental care, mental health services, legal help, medical adherence services and a pharmacy. Whitman-Walker Health annually produces AIDS Walk Washington, which is held in October and is the largest community-based fundraising event for HIVservices in Washington, D.C.

Performance measurement is the backbone of the Whitman-Walker Quality Improvement program. Over the course of each year, the Medical and Operations teams follow 47 performance measures that assess a range of processes and outcomes. Nearly every department at the health center is assessed through at least one performance measure. On the other side of the performance measurement coin, Whitman-Walker has a qualitative evaluation program. Patient feedback boxes are present in waiting rooms at both sites. Discreet services, like HIV testing, STD testing and support groups have continuous satisfaction surveys in place to assess client perception of services. Services requiring enrollment, such as medical, dental and legal care are assessed for client perception using annual client satisfaction surveys. Client satisfaction is assessed using one of these two models in each department. In the near future, QI staff is interested in pursuing enhanced patient experience evaluation methodologies such as periodic focus groups for all patients and routine discovery interviews for new patients. Results of all performance measures, both indicators and patient experience, are shared with consumer, staff and board level quality committees for their input and interpretation.

Four of the performance measures focus directly on identifying patients who are at risk of falling out of care. In addition, patient experience data from surveys and the feedback boxes are compiled and reviewed for issues that could affect patient retention in care. Over time, several strategies have been implemented to improve patient retention based on the results of these assessments.

1. Patient Reminder Calls (before appointments)
2. Follow-up Calls (for missed appointments)
3. Walk-in Appointments for Patients at Risk of Missing Appointments
4. Lists of patients to call who have not been seen in a certain period of time (prioritized by most recent recorded viral load and CD4 results)

Each of these strategies has positively affected patient retention in care; however, some strategies have been more successful than others. For example, allowing patients who routinely miss their appointments to walk-in for care has reduced the amount of waste in provider schedules and has also removed barriers to these patients from coming in when they are able to do so. Allowing patients who likely to no-show for appointments to walk in, significantly decreased the number of missed appointments from 26% to 22%. On the other hand, patient reminder calls have proven to be less efficacious than staff had initially hoped. Reminder calls led to no statistically significant improvement in performance for missed visits, though there was a decrease in negative patient feedback around the level of communication with patients based on this change. Whitman-Walker is proud of its track record in caring for its patients and responding to community needs. They will continue to strive to keep their patients healthy and in care for years to come!

Melanie A Thompson, MD; Michael Mugavero, MD, MHSc; Victoria Cargill, MD, MSCE; Robert Gross, MD, MSCE; et al. Guidelines for Improving Entry Into and Retention in Care and Antiretroviral Adherence for Persons with HIV: evidence-based recommendations from an International Association of Physicians in AIDS Care Panel. Annals of Internal Medicine. 2012;156: 817-833. 

A panel of the International Association of Physicians in AIDS Care (IAPAC) conducted a systematic review of 325 randomized, controlled trials and observational studies with comparators that had at least one measured biological or behavioral end point. Panel members drafted recommendations based on this body of evidence and assigned grades to each intervention method based on overall quality of the evidence and the strength of the recommendation on each intervention method. Quality of the body of the evidence is rated on a four point scale (I to IV), depending on the type of study conducted, the strength of the findings, and the number of limitations related to the results. Strength of the recommendation is graded on a three point scale (A, B, C) depending on the size of the patient group that would potentially benefit from implementation of the intervention method.

The recommendations in these guidelines are for monitoring entry into and retention in care, interventions to improve entry and retention, monitoring of and interventions to improve ART adherence, Recommendations cover ART strategies, adherence tools, education and counseling, and health system and service delivery interventions. In addition, they cover specific issues pertaining to pregnant women, incarcerated individuals, homeless and marginally housed individuals, and children and adolescents, as well as substance use and mental health disorders. Recommendations for future research in all areas are also provided.

You can find a free copy of the IAPAC Guidelines for Improving Entry Into and Retention in Care at this link. In addition, you can find the slides from the September Meet the Author Journal Club that focused on these guidelines at this link.