Assessing Efficacy of a Retention in Care Intervention among HIV Patients with Depression, Anxiety, Heavy Alcohol Consumption & Illicit Drug Use

OBJECTIVE:

We evaluated whether heavy alcohol use, illicit drug use or high levels of anxiety and depression symptoms were modifiers of the Retention through Enhanced Personal Contact ('REPC') intervention. The intervention had previously demonstrated overall efficacy in the parent study.

METHODS:

A total of 1,838 patients from 6 U.S. HIV clinics were enrolled into a randomized trial in which intervention patients received an "enhanced contact" protocol for 12 months. All participants completed an ACASI interview that measured depression and anxiety symptoms from the Brief Symptom Inventory, alcohol use from the AUDIT-C instrument, and drug use from the WHO (ASSIST) questions. The 12-month binary outcome was completing an HIV primary care visit in three consecutive 4-month intervals. The outcome was compared between intervention and standard of care patients within subgroups on the effect modifier variables using log-binomial regression models.

RESULTS:

Persons with high levels of anxiety or depression symptoms and those reporting illicit drug use, or heavy alcohol consumption had no response to the intervention. Patients without these "higher-risk" characteristics responded significantly to the intervention. Further analysis revealed higher-risk patients were less likely to have successfully received the telephone contact component of the intervention. Among higher-risk patients who did successfully receive this component, the intervention effect was significant.

CONCLUSIONS:

Our findings suggest that clinic-based retention in care interventions are able to have significant effects on HIV patients with common behavioral health issues, but the design of those interventions should assure successful delivery of intervention components to increase effectiveness

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By:  Gardner LI1, Marks G, Shahani L, Giordano TP, Wilson TE, Drainoni ML, Keruly JC, Batey DS, Metsch LR.

• 1Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, GA 
• Department of Medicine, Baylor College of Medicine, Center for Innovations in Quality, Effectiveness, and Safety, Michael E. DeBakey VA Medical Center, Houston, TX
• Department of Medicine, Baylor College of Medicine, Medical Director of HIV Services, Thomas Street Health Center and Harris Health System, Center for Innovations in Quality, Effectiveness, and Safety, Michael E. DeBakey VA Medical Center, Houston, TX 
• Department of Community Health Sciences School of Public Health, State University of New York, Downstate Medical Center, Brooklyn, NY 
• Department of Health Policy & Management, Boston University School of Public Health, Center for Healthcare Organization and Implementation Research, Edith Nourse Rogers Memorial VA Hospital, Department of Medicine, Boston University School of Medicine, Boston, MA 
• Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD 
• Research & Informatics Service Center (RISC), University of Alabama-Birmingham, Birmingham, AL 
• Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, NY.
• AIDS. 2016 Jan 11.  

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