Stay Connected for Your Health helps clients stay engaged in HIV medical care through clinic-wide messaging, enhanced personal contact, and behavioral skills training. Funded by the Centers for Disease Control and Prevention (CDC) and originally implemented by six academically affiliated HIV clinics nationwide more than 10 years ago, this 12-month intervention has become well-established and is incorporated in many provider trainings. Evaluations show that people with HIV receiving behavioral skills training and personalized and frequent positive messages about care engagement were more likely to be engaged in care.
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Regular attendance at HIV medical appointments promotes viral suppression, yet research has found that many clients do not stay engaged in care. The CDC estimates that only 51% of people with HIV are retained in care.1 Patients with behavioral health issues or who experience stigma or structural barriers such as lack of housing, job, transportation, or health care coverage have lower rates of retention in care.2 Stay Connected for Your Health was developed to improve HIV retention in care for clients with a new diagnosis of HIV and for those who faced challenges attending their medical appointments regularly.
“Timely initial and continuing engagement in care are critical to allow uninterrupted access to ART and sustained viral suppression.”
Clients were paired with a retention specialist who motivated them to stay engaged in care. First, the specialist established a personal relationship with the client through a one-on-one meeting. Then, the client and retention specialist met in person throughout the year; during these meetings, the specialist encouraged the client to attend all medical appointments. The retention specialist called clients between their scheduled appointments and made reminder phone calls seven and two days before the next appointment. The retention specialist also called the client 24 hours after missing an appointment.
Staff throughout the clinic, including clinicians, medical assistants, support staff, and administrators, greeted clients warmly and provided them with encouraging messages about staying engaged in care. Posters and brochures in the waiting and exam rooms reinforced these messages.
Clients received a one-hour training on communication with providers, organizational skills, and problem-solving skills. Content was tailored to each participant based on an unmet needs assessment. Retention specialists also helped create plans to address every client’s unmet needs and to assist with support services, such as referrals to case managers. Overall, retention specialists used strengths-based interactions to help clients identify and meet their health goals.
Clients with unmet needs were referred to additional supports, including housing, substance use, and mental health services.
Stay Connected for Your Health was originally evaluated between 2010 and 2012 and studied in two phases. The first phase assessed the clinic-level intervention related to posters, brochures, and positive messages from staff by analyzing retention in care before and after the intervention. The second phase involved a study of 1,838 clients assigned to a Stay Connected for Your Health (intervention) group or a standard of care (control) group. Both phases found that the intervention was associated with better retention in care than the Standard of Care.
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Sources: Gardner LI, Marks G, Craw JA, et al. A low-effort, clinic-wide intervention improves attendance for HIV primary care. Clin Infect Dis. 2012;55(8):1124-1134. Gardner LI, Giordano TP, Marks G, et al. Enhanced personal contact with HIV patients improves retention in primary care: a randomized trial in 6 US HIV clinics. Clin Infect Dis. 2014 Sep 1;59(5):725–34.
“…we designed intervention efforts that focused on increasing knowledge about the importance of retention, on promoting motivation to attend HIV primary care visits, and on developing both the self-efficacy to attend appointments and the requisite communication, organization, and problem-solving skills needed to achieve this goal.”
- Use of the information-motivation-skills model. The skills component of the intervention is based on the information-motivation-skills model. Used successfully in other HIV-related interventions, this model provides a framework for increasing knowledge about the importance of medication adherence, motivating clients to attend HIV primary care visits, and building behavioral skills to achieve their HIV primary care goals.
- Training for retention specialists. The retention specialists who contacted clients were trained during a multiple-day workshop before the start of the intervention. This training consisted of didactic and interactive sessions that equipped the retention specialists with teaching skills needed for guiding interactions and motivating clients to keep their appointments.
- Job aids. Pockets guides for clinicians and non-clinical staff can offer examples of supportive messages. Staff can be gently reminded to continue messaging through paper sticker charts that track contacts and electronic health record prompts.
- Creation of a leadership team. The implementation manual suggests that providers form a leadership team, including a clinician champion and intervention coordinator, to support Stay Connected for Your Health activities. The clinician champion can provide a vision for implementation and guidance on day-to-day activities, as well as secure funding and leadership buy-in. The intervention coordinator can organize trainings, supervise retention specialists, and ensure that all staff are consistently providing the supportive messaging.
This project was initially funded by the CDC; its main ongoing cost is the retention specialist. Providers may choose to hire a separate staff person to serve as the retention specialist, but work could be split across multiple staff people if a new hire is not feasible.
- Evaluation results suggested that improvements in retention in care may be driven more by personal connections between the retention specialists and clients than by the intervention’s basic skills training.
- Certain clients benefited less from the intervention, including individuals with substance use disorders and those with other unmet needs. Therefore, providers may need to supplement Stay Connected for Your Health activities with more intensive case management and behavioral health services.
“A concerted effort to help patients resolve unmet needs would provide a context in which a behavioral intervention is more likely to universally improve retention in care.”
- Gardner LI, Giordano TP, Marks G, et al. Enhanced personal contact with HIV patients improves retention in primary care: a randomized trial in 6 US HIV clinics. Clin Infect Dis. 2014 Sep 1;59(5):725–34. doi: 10.1093/cid/ciu357.
- Gardner LI, Marks G, Craw JA, et al. A low-effort, clinic-wide intervention improves attendance for HIV primary care. Clin Infect Dis. 2012;55(8):1124-1134. doi:10.1093/cid/cis623
