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Prioritization of Evidence-Based and Evidence-Informed Interventions for Retention in Medical Care for Persons with HIV

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Abstract

Up to 50% of those diagnosed with HIV in the U.S. are not retained in medical care. Care retention provides opportunity to monitor benefits of HIV therapy and enable viral suppression. To increase retention, there is a need to prioritize best practices appropriate for translation and dissemination for real-world implementation. Eighteen interventions from CDC’s Compendium of Evidence-Based Interventions were scored using the RE-AIM framework to determine those most suitable for dissemination. A CDC Division of HIV Prevention workgroup developed a RE-AIM scale with emphasis on the Implementation and Maintenance dimensions and less emphasis on the Efficacy dimension since all 18 interventions were already identified as evidence-based or evidence-informed. Raters referenced primary efficacy publications and scores were averaged for a ranked RE-AIM score for interventions. Of 18 interventions, four included care linkage and 7 included viral suppression outcomes. Interventions received between 20.6 and 35.3 points (45 maximum). Scores were converted into a percentage of the total possible with ranges between 45.8 and 78.4%. Top four interventions were ARTAS (78.4%); Routine Screening for HIV (RUSH) (73.2%); Optn4Life (67.4%) and Virology Fast Track (65.9%). All four scored high on Implementation and Maintenance dimensions. Select items within the scale were applicable to health equity, covering topics such as reaching under-served focus populations and acceptability to that population. Navigation-enhanced Case Management (NAV) scored highest on the health equity subscale. RE-AIM prioritization scores will inform dissemination and translation efforts, help clinical staff select feasible interventions for implementation, and support sustainability for those interventions.

Resumen

Hasta el 50% de las personas diagnosticadas con VIH en USA no son retenidos en cuidados médicos impactando su monitoreo y supresión viral. Dieciocho intervenciones de retención fueron evaluadas utilizando el marco RE-AIM para determinar su adecuación para la difusión. Evaluadores promediaron las intervenciones. Cuatro intervenciones incluyeron enlace de atención y 7 supresión viral. Las cuatro intervenciones principales fueron ARTAS, detección de rutina para el VIH, Optn4Life y Vía rápida de virología. Elementos del marco fueron usados para evaluar equidad en salud y cubrieron temas de cómo llegar a las poblaciones desatendidas y la aceptabilidad de esa población. La intervención gestión de casos para mejorar con navegación (NAV) obtuvo la puntuación más alta en la subescala de equidad. RE-AIM y los puntajes de priorización de equidad informarán los esfuerzos de difusión y traducción, ayudarán al personal clínico a seleccionar las intervenciones para la implementación y apoyarán la sostenibilidad.

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Acknowledgements

Disclaimer required by the CDC: The findings and conclusions in this manuscript are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention.

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Funding was provided by Centers for Disease Control and Prevention.

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Authors and Affiliations

  1. Division of HIV Prevention, National Center for HIV, Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, 1600 Clifton Road, Mailstop E40, Atlanta, GA, USA

    Charles B. Collins, Darrel Higa, Jocelyn Taylor, Carolyn Wright, Kimberly H. Murray, Marc Pitasi, Yvonne Greene, Cynthia Lyles, Arlene Edwards, Jonny Andia, JoAna Stallworth & Jorge Alvarez

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  1. Charles B. Collins
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  2. Darrel Higa
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  3. Jocelyn Taylor
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Contributions

All authors contributed to the study design. Material preparation, data collection and analysis were performed by CBC, Jr., MP, KHM, YG, JT, CW, JA, JA, DH and CL. The first draft of the manuscript was written by CBC, Jr. and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript. All authors whose names appear on the submission: (1) made substantial contributions to the design of the RE-AIM instrument used in the analysis and interpretation of data; (2) drafted sections of the work or revised it critically for important intellectual content; (3) approved the version to be cleared by the CDC and then submitted for publication; and (4) agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. As a review article, Charles B Collins, Jr. and Cindy Lyles had the initial idea for the article, Darrel Higa performed the literature search, data analysis was conducted by all listed authors, Charles B. Collins, Jr. wrote the first draft, and all other authors critically revised the work.

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Correspondence to Charles B. Collins.

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The authors have no relevant financial or non-financial interests to disclose. The authors have no competing interests to declare that are relevant to the content of this article. All authors certify that they have no affiliations with or involvement in any organization or entity with any financial interest or non-financial interest in the subject matter or materials discussed in this manuscript. The authors have no financial or proprietary interests in any material discussed in this article.

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Collins, C.B., Higa, D., Taylor, J. et al. Prioritization of Evidence-Based and Evidence-Informed Interventions for Retention in Medical Care for Persons with HIV. AIDS Behav 27, 2285–2297 (2023). https://doi.org/10.1007/s10461-022-03958-1

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