Effectiveness of Data-to-Care Proactive Adherence Interventions on Retention and Relinkage to HIV Care Amid COVID Pandemic

OBJECTIVES: Forty percent of people with HIV (PWH) are unable to achieve HIV viral suppression. Viral suppression is facilitated by engagement in care (relinkage) and routine follow-up (retention) with medical visits; however, multiple barriers impact both. This study evaluated the effect of adherence interventions on retention and relinkage to medical visits.

METHODS: This was a prospective study including PWH at 2 HIV clinics, who failed to pick up antiretroviral medications ≥30 days from the last fill per prescription claims from November 2020-December 2021. Eligible patients had interventions attempted (e.g. in-person/telephone counseling, text/voicemail messaging). “No intervention” was documented for those unreachable. Retention was defined as ≥2 medical visits ≥90 days apart and relinkage was defined as ≥1 medical visit. Index date was the date of intervention eligibility. The 365-day pre- (baseline) and post- (follow-up) index periods were evaluated for outcomes. Odds of retention and relinkage were calculated and adjusted for demographic and clinical measures.

RESULTS: Included were 1,187 patients (66% male; 74% African American; mean (SD) age 47 (13.7) years). The change (baseline to follow-up) in the percentage of PWH retained in care was -2.3% (40.1% to 37.8%) and -3.9% (52.3% to 48.4%) for the intervention and no intervention group, respectively. A change of -4% (49.4 to 45.4) and -8.1% (64.6 to 56.5) of PWH relinked to care for the intervention and no intervention group was noted, respectively. There was no difference in the odds of retention (adjusted odds ratio [AOR], 0.95; 95% CI, 0.55-1.65) or relinkage (AOR, 1.11; 95% CI, 0.31-3.94).

CONCLUSIONS: The percent reduction in PWH retained and relinked to care was smaller in the intervention group compared to no intervention. This study was completed during the COVID-19 pandemic impacting visit patterns. Additional research is needed to quantify the effectiveness of adherence support interventions among PWH.