The Cooperative Re-Engagement Controlled Trial (CoRECT) was a data to care (D2C) project to identify and reengage people with HIV who were newly out of care. The study, which ran from 2016-2018 with funding from the Centers for Disease Control and Prevention (CDC), was a collaborative effort between the CDC and two state jurisdictions—the Connecticut Department of Health/Yale School of Medicine and the Massachusetts Department of Public Health—and one city jurisdiction, the Philadelphia Department of Public Health. The CoRECT approach used multiple modalities to reengage people in care. It included a clinic and health department data reconciliation process to identify missed laboratory results or appointments and create the out-of-care list, case discussions via telephone to review the combined list, and field epidemiologist outreach to assist clients with making appointments, securing transportation, and arranging referrals. The intervention employed Antiretroviral Treatment and Access to Services (ARTAS) strengths-based case management techniques and motivational interviewing to contact identified people within 30 days, reengage them in care, and reduce time to viral suppression.
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The CoRECT project focused on reengaging people in care, responding to significant unmet need among people who are aware of their HIV status but not engaged in care. The initiative included 23 clinics in four counties in Connecticut, nine clinics in four counties in Massachusetts, and eight clinics in Philadelphia. It sought to contribute to the evidence base about using data to care (D2C) approaches, an emerging strategy at the time of the project, to identify and reengage people in care. CoRECT was the first prospective randomized controlled trial (RCT) to implement and evaluate a health department based D2C effort in three regions with the ultimate goal of improving HIV care continuum outcomes and supporting the goals of ending the HIV epidemic in the U.S.1
The participating health departments partnered with collaborating HIV clinical care sites (CoRECT clinics) to create ‘newly out-of-care’ lists based on missed clinical appointments and lack of recent CD4 or viral load lab results in HIV surveillance data. Health department and clinic lists were reconciled and then included in monthly case conferencing discussions that resulted in final determinations of who to include on the out-of-care list. People on the confirmed out-of-care list were then randomized to receive the D2C intervention or the current standard of care, which typically included calls, letters, or email outreach.
The intervention arm of the RCT varied by participating site, but generally focused on using trained health department staff, mainly Disease Intervention Specialists (DIS) or field epidemiologists, to locate people on the out-of-care list, establish contact, and help individuals to access care. Approaches to contact people included phone, text, mail, social media, and field visits. Once people were successfully contacted, outreach staff helped them obtain appointment slots, meet transportation needs, and access case management and other services as needed (e.g., health care coverage assistance). All jurisdictions aimed to make initial contact with individuals on the confirmed out-of-care lists within 30 days.
Connecticut and Philadelphia both used a strengths-based case management model, ARTAS, to reengage people in care. The ARTAS model uses a five-session approach that emphasizes clients’ strengths as part of the care engagement process. Similarly, the Massachusetts jurisdictions incorporated motivational interviewing techniques into their contacts with clients.
The final study included enrollments of 654 (Connecticut), 630 (Massachusetts), and 609 (Philadelphia) in both arms of the intervention for a total enrollment of 1,893. Most participants were male (ranging from 62% to 74% across the three sites) and the largest racial/ethnic group was non-Hispanic Black (ranging from 40% to 65% across the three sites).1 People in the intervention arm were more likely to be reengaged in HIV care, retained in HIV care, and become virally suppressed.
| Category | Information |
|---|---|
| Evaluation data | Appointment data and HIV laboratory results from HIV surveillance systems in the different jurisdictions (Connecticut, Massachusetts, and Philadelphia). |
| Measures |
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| Results |
*statistically significant |
Source: Fanfair RN, Khalil G, Williams T, et al. The Cooperative Re-Engagement Controlled Trial (CoRECT): A randomised trial to assess a collaborative data to care model to improve HIV care continuum outcomes. Lancet Reg Health Am. 2021;3:100057.
D2C model and data sharing. This study was the first multi-site RCT to evaluate D2C approaches to promote care reengagement, retention in care, and viral suppression among people with HIV who were out-of-care. The D2C model focused on collaboration between the health departments and clinical providers to reconcile test and appointment information to determine true out-of-care status. This required setting up data sharing agreements between the health departments and HIV clinical sites.
Use of DIS or field epidemiologists. CoRECT relied on DIS or field epidemiologists to reengage people in care. These roles have traditionally focused on infectious disease control and HIV partner notification but can serve in a patient navigator capacity to reengage patients in care. Unlike clinic case managers, DIS are typically not required to obtain patient consent for release of information, which removes a barrier to engagement.
Use of ARTAS and motivational interviewing. While implementation varied at the three participating sites, CoRECT used ARTAS and/or motivational interviewing techniques to engage people in care and improve navigation to needed services. All staff who conducted outreach and engaged people in care were trained on the ARTAS strengths-based case management approach or motivational interviewing methods.
The intervention received funding from the Division of HIV Prevention, CDC (Clinical Trial number NCT02693145). The clinic settings at the participating sites varied, but relied on various funding sources, including RWHAP funding, to support normal operations.
- The collaborative D2C approach that brought together health department staff and clinical providers in case conferences and data reconciliation processes was identified as a key element for identifying people with HIV who were newly out-of-care. It improved accuracy of out-of-care lists and may have contributed to the positive results for reengagement in HIV care.
- The researchers also identified the use of DIS or field epidemiologists as a key facilitator for locating people with HIV who were out-of-care. The effective case conference and data reconciliation approach, which led to more accurate out-of-care lists, also increased efficiency and workflow for DIS staff, who could spend less time making contact with people who were not actually out of care.
- The strengths-based case management model and use of motivational interviewing techniques may have also improved reengagement in care and increased the use of “warm handoffs” for referrals to needed services.
- The intervention demonstrated successful reengagement among various priority populations, including non-Hispanic Black people and men who have sex with men.
“Overall, this study provides evidence that a collaborative D2C model is an effective strategy to identify, locate, and reengage out-of-care persons with HIV infection, including hard-to-reach populations.”
