People living with HIV (PWH) and preventing the spread of the virus depend on consistent, long-term care. Researchers analyzed whether or not re-engaging PWH who were at danger of dropping out of care may be prompted by early detection systems. About 20 healthcare centers (HCCs) from the AIDS Healthcare Foundation participated in this cluster randomized controlled study, with 10 HCCs assigned to an intervention group and 10 to a control group; all HCCs in both groups continued their previous retention strategies. Clinic personnel were alerted to PWH at risk of dropping out of care via daily automated flags in CHORUSTM, a mobile app and web-based reporting tool based on data from electronic health records. Logistic regression models adjusted for clustering using generalized estimating equations (independent correlation structure) were used to examine the correlation between the intervention and subsequent visits among PWH who had been flagged.
Models accounted for factors such as location, HCC population size, and percentages of Hispanic and Ryan White Program patients to account for variations between HCCs. Among the 15,875 PWH receiving care, 56% were flagged; of those who were seen, 76% were seen within 2 months of being flagged (intervention) and 75% were seen within 3 months (control). In adjusted analyses, flags had higher odds of being followed by a visit (odds ratio [OR]: 1.08, 95% confidence interval [CI]: 0.97, 1.21) or a visit within 2 months (OR: 1.07, 95% CI: 0.97, 1.17) at intervention than control HCCs. The proportion of PWH at risk whose viral load was less than 50 copies/mL at the study’s beginning and end increased in both trial arms, but more so in the intervention arm (65% to 74%) than the control (62% to 67%) HCCs.
PWH identified as at-risk of falling out of care were slightly more likely to return for care at intervention than control HCCs, and a greater proportion achieved undetectability, despite the challenges of the COVID-19 pandemic, adding an intervention to existing retention efforts, and the reality that behavior change takes time. CHORUSTM retention module has the potential to increase the number of people who remain in care after HIV testing, which in turn reduces the risk of HIV transmission.