The Partners in+care Planning Committee is seeking new members to help design innovative and value-added programming for the in+care Campaign. Campaign staff is specifically looking for people with HIV and those that support them to engage in conversations around quality improvement and retention in care. Some experience in discussing and working on quality improvement matters is preferred, but anyone seeking to make a difference is welcome.

Meetings of Partners in+care participants are held on the third Monday of each month at 1pm ET. Topics of conversation revolve around Facebook postings, webinar development, and Partners in+care Toolkit development. If you are interested in joining the Partners in+care Planning Group, email Michael Hager at Michael@NationalQualityCenter.org. Get involved today and leave your mark on this important national endeavor!

Fifteen months into the in+care Campaign, one of the most important structural interventions to improve patient retention in HIV care is communication and integration of efforts within communities. This not only includes horizontal integration (discussion of retention issues across provider agencies at Planning Council, Community Fora, etc), but also includes vertical integration (inclusion of grantee lead agencies and ultimate funders in the dialogue). Integration of efforts on these levels is important  since no one agency works in a vacuum. In fact, many agencies within a community may be in contact with a single patient or groups of patients.

What efforts have been made in your community to bring provider agencies of all types together to discuss the issue of patient retention in HIV care? Have you included your network lead agencies and your funders in these conversations? There are many ways that these types of meetings can be convened and there is no right answer in terms of how to get the ball rolling for these meetings. Your Campaign Quality Coaches are excellent resources available to help you think through these types of meetings - whom to invite, what the agenda should have on it, is a face-to-face or virtual meeting better? Michael Hager is also available to help you think through these questions. Email him at Michael@NationalQualityCenter.org.

While the term "retention in care" may seem to imply that retention is primarily the responsibility of clinical staff, Ryan White grantees are increasingly involving social service providers in their efforts to support patient retention.

Health Educators

The Gurabo Community Health Center in Gurabo, PR uses health educators to identify patients who have missed medical appointments or have not completed their laboratory follow up. Once patients are identified, they are contacted and referred to a clinical case manager. A major barrier to accessing care remains transportation. To address this barrier, outreach staff provides transportation, when necessary. Another challenge faced by the health center related to the rescheduling of missed appointments due to a temporary lack of a medical clerk. The scheduling issues were resolved once these administrative services were reinstated.

Peer Mentors

Peer mentors help to support HIV-infected women who receive services from the University of Medicine and Dentistry of New Jersey, Robert Wood Johnson Medical School AIDS Program (RWJAP) in Piscataway, New Jersey. The peer mentors contact patients and discuss strategies to help the patients remain in or return to care. The mentor focuses on the reasons behind missed appointments, missed refills, and the need for other ancillary care (e.g., Pap smear). Some of the challenges facing the patients include job loss, insurance lapse, inability to complete paperwork for entitlements, treatment fatigue, substance abuse, mental illness, and issues within personal relationships. Having experienced many of these challenges, the peer mentor can serve to engage the patient and share their own experiences about overcoming similar challenges.

Medical Case Managers

In the Broward County Part A EMA, medical case managers were tasked with reviewing their case loads to ensure that those patients who appear inactive are contacted to determine whether they need assistance getting back into care or if they should be discharged from medical case management. In addition, the EMA addressed several documentation and data entry issues to ensure that the data accurately reflect patient retention rates. After resolving the data issues and reviewing caseloads, the EMA is exploring ways to take a proactive approach to prevent clients from falling out of care.

Smith, L.R., Fisher, J.D., Cunningham, C.O., et al. Understanding the behavioral determinants of retention in HIV care: a qualitative evaluation of a situated information, motivation, behavioral skills model of care initiation and maintenance. AIDS Patient Care 2012; 26(6): 344-355

  
The researchers used a mixed-methods qualitative analysis to identify the content and context of significant theory-based determinants related to retention in HIV care and to evaluate the applicability of the sIMB model. Qualitative data were collected via in-depth, semi-structured interviews with a sample of patients accessing traditional and nontraditional HIV care services in the Bronx, NY. Patients in the sample experienced many of the comordidities associated with HIV (e.g., substance abuse disorders, mental illness, hepatitis C).

Through analysis of interviews with study participants, sIMB model-based content was identified in all but 7.1 percent of the statements discussing facilitators or barriers to retention in HIV care. Factors influencing retention in care that were identified by participants included:

        * Acceptance of diagnosis;
        * Stigma;
        * HIV cognitive/physical impairments; and
        * Global constructs of self-care.

The results indicate that participants' experiences are reflective of the content and structure of the sIMB model and provide a systematic classification of important theoretical and contextual determinants of retention in HIV care. The researchers suggest that the model's determinants--information, motivation, behavioral skills-could play an important role in interventions designed to support retention. This work is useful in that it moves known correlates of retention in HIV care into a full-fledged and functional model.