Low-Resource Behavioral Intervention May Help Promote Retention in HIV Care

Right now, there are 1.1 million individuals in the United States currently living with HIV, and 1 in 7 are not even aware of infection. With antiretroviral therapy, a diagnosis no longer equates to a death sentence—but it only works if individuals adhere to their treatment regimen. Once an individual has HIV, they have it for life, and thus, they also need to receive treatment for the rest of their lives.

For this reason, “retention in care” has been a central focus for many HIV researchers. Retention in care is needed to achieve optimal clinical outcomes in those living with HIV. Furthermore, “retention in care for all patients provides additional benefits through ancillary services, social support, and secondary prevention messages that can help patients navigate a lifelong and complicated infection.” However, one stumbling block is that many programs that successfully retain individuals with HIV in care consume considerable time and resources.

Researchers from the University of California at San Diego, the University of Michigan in Ann Arbor, and the University of Connecticut, looked at this issue against the backdrop of the fact that more than half of those living with HIV in the United States have difficulty remaining engaged with their care.

This group of researchers has published a pilot study in AIDS Care that describes a 60-minute intervention to retention in care. The program—60 Minutes for Health— is a practical, theory-based behavioral intervention designed to be delivered in a single session using few resources. It targets individuals with HIV who experienced a gap in care exceeding 6 months. For these reasons, 60 Minutes for Health could be advantageous, particularly in the busy clinic setting.

60 Minutes for Health employs a few principles to engage nonadherent patients:

• The program addresses substance use, depression, transportation, competing priorities, and the patient's feelings about HIV infection and possible stigmatization.
• The program also addresses participants’ misperceptions, attitudes and beliefs.
• A health educator works with participants through a semi-structured intervention using an illustrated workbook.
• The program leverages patients’ physical health priorities to improve care retention.

In this pilot study, the researchers randomly assigned patients to either the 60 Minutes for Health program or a diet/nutrition arm. Ultimately, 16 patients consented to participate in the study. Compared with controls, participants who engaged in 60 Minutes for Health had significantly better retention in the 12 months after the intervention, with 63% of intervention-treated patients remaining retained, as opposed to 25% of control group participants.

The authors noted that this is a small/pilot study, and so, it is difficult to extrapolate findings to a larger group. However, having demonstrated that this short intervention is feasible and cost-effective, this study lays the groundwork to try 60 Minutes for Health at other locations.

In the future, researchers propose to conduct a larger study to assess the program’s efficacy in busy clinics in many different settings.