Health department-HIV clinic integration of data and human resources to re-engage out of care HIV-positive persons into clinical care in a New York City locale

ABSTRACT

We describe an enhanced data to care (eD2C) initiative combining New York City (NYC) Department of Health and Mental Hygiene (DOHMH) HIV surveillance data and a collaborating HIV clinic records to identify and re-engage into care persons living with HIV (PLWH), and presumed to be out of care (OOC). DOHMH identified presumed-OOC persons who lacked recent HIV-related laboratory test reports (e.g., viral load, CD4) in the NYC surveillance registry, and whose last laboratory reports were from the collaborating clinic. The clinic then obtained the current care status of the presumed-OOC persons per their medical record system. The final list of persons deemed to be OOC by DOHMH and clinic were given to a clinic patient navigator and DOHMH disease intervention specialist (DIS) for re-engagement in care efforts. The initiative was a pilot effort aimed at reducing the inefficiencies (e.g., persons current with care, but deemed to be OOC) inherent in routine data to care (rD2C), using surveillance data or clinic medical records alone. Significantly, fewer PLWH, presumed to be OOC in eD2C than DOHMH rD2C were found to be current with care (2% vs. 16%, P = <.001). After adjusting for significant characteristics, time since OOC and years since HIV diagnosis, the odds of re-engaging in HIV care were significantly higher among eD2C (aOR: 2172.31; 95% CI: 1171.23–4044.36) than the rD2C group. We demonstrated the feasibility of leveraging DOHMH and HIV clinic data and human resources to potentially gain efficiencies in efforts to re-engage and retain PLWH in HIV care.

KEYWORDS:

• HIV
• data to care
• out of care
• engagement in care
• retention in care
• health departments

Acknowledgements

The authors thank Sarah Braunstein, PhD, MPH, Oni Blackstock, MD, MHS, James Hadler MD, MPH, Kent A. Sepkowitz, MD, MPH, and Demetre Daskalakis, MD, MPH for substantive comments on the draft manuscript. Data was presented in part at the IAPAC. 13th International Conference on HIV Treatment and Prevention Adherence – Miami Florida, USA, 8–10 June 2018.

Disclosure statement

No potential conflict of interest was reported by the authors.

Additional information

Funding

Funding for this program was provided by Ryan White HIV Care program Part A, Grant #93.914.