Interventions to Improve Retention in HIV Primary Care: A Systematic Review of U.S. Studies
Behavioral Aspects of HIV Management (RJ DiClemente and JL Brown, Section Editors)
First Online: 21 September 2012 DOI:
10.1007/s11904-012-0136-6 Cite this article as: Higa, D.H., Marks, G., Crepaz, N. et al. Curr HIV/AIDS Rep (2012) 9: 313. doi:10.1007/s11904-012-0136-6 Abstract
Retaining HIV-diagnosed persons in care is a national priority, but little is known on what intervention strategies are most effective for promoting retention in care. We conducted a systematic search and qualitatively reviewed 13 published studies and three recent conference presentations to identify evidence-informed retention strategies. We extracted information on study design, methods, and intervention characteristics. Strengths-based case management that encourages clients to recognize and use their own internal abilities to access resources and solve problems offered strong evidence for retention in care. Other evidence-informed strategies included peer navigation, reducing structural- and system-level barriers, including peers as part of a health care team, displaying posters and brochures in waiting rooms, having medical providers present brief messages to patients, and having clinics stay in closer contact with patients across time. Opportunities for additional intervention strategies include using community-based organizations as a setting for engaging HIV-infected persons about the importance of regular care and involving patients’ significant others in retention in care interventions.
Keywords HIV Care Retention Intervention Behavioral aspects of HIV management Health care team
The findings and conclusions in this report are those of the authors and do not necessarily represent the views of the U.S. Centers for Disease Control and Prevention.
References Papers of particular interest, published recently, have been highlighted as: • Of importance
CDC. Vital signs: HIV prevention through care and treatment--United States. MMWR Morb Mortal Wkly Rep. 2011;60(47):1618–23.
Office of National AIDS Policy. National HIV/AIDS strategy for the United States. Washington, DC: Office of National AIDS Policy. Available at:
. Accessed December 13, 2010.
Gardner EM, McLees MP, Steiner JF, Del Rio C, Burman WJ. The spectrum of engagement in HIV care and its relevance to test-and-treat strategies for prevention of HIV infection. Clin Infect Dis. 2011;52(6):793–800.
Bani-Sadr F, Bedossa P, Rosenthal E, et al. Does early antiretroviral treatment prevent liver fibrosis in HIV/HCV-coinfected patients? J Acquir Immune Defic Syndr. 2009;50(2):234–6.
Mugavero MJ, Amico KR, Westfall AO, et al. Early retention in HIV care and viral load suppression: implications for a test and treat approach to HIV prevention. J Acquir Immune Defic Syndr. 2012;59(1):86–93.
Giordano TP, Gifford AL, White Jr AC, et al. Retention in care: a challenge to survival with HIV infection. Clin Infect Dis. 2007;44(11):1493–9.
Mugavero MJ, Lin HY, Willig JH, et al. Missed visits and mortality among patients establishing initial outpatient HIV treatment. Clin Infect Dis. 2009;48(2):248–56.
Park WB, Choe PG, Kim SH, et al. One-year adherence to clinic visits after highly active antiretroviral therapy: a predictor of clinical progress in HIV patients. J Intern Med. 2007;261(3):268–75.
Berg MB, Safren SA, Mimiaga MJ, Grasso C, Boswell S, Mayer KH. Nonadherence to medical appointments is associated with increased plasma HIV RNA and decreased CD4 cell counts in a community-based HIV primary care clinic. AIDS Care. 2005;17(7):902–7.
Metsch LR, Pereyra M, Messinger S, et al. HIV transmission risk behaviors among HIV-infected persons who are successfully linked to care. Clin Infect Dis. 2008;47(4):577–84.
Fleishman JA, Moore RD, Conviser R, Lawrence PB, Korthuis PT, Gebo KA. Associations between outpatient and inpatient service use among persons with HIV infection: a positive or negative relationship? Health Serv Res. 2008;43(1 Pt 1):76–95.
Aberg JA, Gallant JE, Anderson J, et al. Primary care guidelines for the management of persons infected with human immunodeficiency virus: recommendations of the HIV Medicine Association of the Infectious Diseases Society of America. Clin Infect Dis. 2004;39(5):609–29.
Cheever LW. Engaging HIV-infected patients in care: their lives depend on it. Clin Infect Dis. 2007;44(11):1500–2.
Hall HI, Gray KM, Tang T, Li J, Shouse L, Mermin J. Retention in care of adults and adolescents living with HIV in 13 U.S. areas. J Acquir Immune Defic Syndr. 2012;60(1):77–82.
• Marks G, Gardner L, Craw JA, Crepaz N. Entry and retention in medical care among HIV-diagnosed persons in the United States: a meta-ananlysis. AIDS. 2010;24(17):2665–78.
A study that meta-analyzed 28 findings from observational study of retention in HIV care
Cabral HJ, Tobias C, Rajabiun S, et al. Outreach program contacts: do they increase the likelihood of engagement and retention in HIV primary care for hard-to-reach patients? AIDS Patient Care STDS. 2007;21 Suppl 1:S59–67.
Ulett KB, Willig JH, Lin HY, et al. The therapeutic implications of timely linkage and early retention in HIV care. AIDS Patient Care STDS. 2009;23(1):41–9.
Magnus M, Jones K, Phillips G, et al. Characteristics associated with retention among African American and Latino adolescent HIV-positive men: results from the outreach, care, and prevention to engage HIV-seropositive young MSM of color special project of national significance initiative. J Acquir Immune Defic Syndr. 2010;53(4):529–36.
Marx KA, Malka ES, Ravishankar J, Schwartz RM. Measurement of retention in care among adults infected with HIV in an urban clinic. AIDS Care. 2011;23(10):1298–304.
Catz SL, McClure JB, Jones GN, Brantley PJ. Predictors of outpatient medical appointment attendance among persons with HIV. AIDS Care. 1999;11(3):361–73.
Stein MD, Crystal S, Cunningham WE, et al. Delays in seeking HIV care due to competing caregiver responsibilities. Am J Public Health. 2000;90(7):1138–40.
Williams B, Amico KR, Konkle-Parker D. Qualitative assessment of barriers and facilitators to HIV treatment. J Assoc Nurses AIDS Care. 2011;22(4):307–12.
Tobias CR, Cunningham W, Cabral HD, et al. Living with HIV but without medical care: barriers to engagement. AIDS Patient Care STDS. 2007;21(6):426–34.
Goldstein RB, Rotheram-Borus MJ, Johnson MO, et al. Insurance coverage, usual source of care, and receipt of clinically indicated care for comorbid conditions among adults living with human immunodeficiency virus. Med Care. 2005;43(4):401–10.
Turner BJ, Cunningham WE, Duan N, et al. Delayed medical care after diagnosis in a US national probability sample of persons infected with human immunodeficiency virus. Arch Intern Med. 2000;160(17):2614–22.
Bakken T. Constitutional and social equality: legacies and limits of law, politics and culture. Indian J Gend Stud. 2000;7(1):71–82.
Kinsler JJ, Wong MD, Sayles JN, Davis C, Cunningham WE. The effect of perceived stigma from a health care provider on access to care among a low-income HIV-positive population. AIDS Patient Care STDS. 2007;21(8):584–92.
Beckerman A, Fontana L. Medical treatment for men who have sex with men and are living with HIV/AIDS. Am J Mens Health. 2008;3(4):319–29.
Cunningham CO, Sohler NL, Korin L, Gao W, Anastos K. HIV status, trust in health care providers, and distrust in the health care system among Bronx women. AIDS Care. 2007;19(2):226–34.
Kalichman SC, Graham J, Luke W, Austin J. Perceptions of health care among persons living with HIV/AIDS who are not receiving antiretroviral medications. AIDS Patient Care STDS. 2002;16(5):233–40.
Aidala AA, Lee G, Abramson DM, Messeri P, Siegler A. Housing need, housing assistance, and connection to HIV medical care. AIDS Behav. 2007;11 Suppl 6:101–15.
Smith MY, Rapkin BD, Winkel G, Springer C, Chhabra R, Feldman IS. Housing status and health care service utilization among low-income persons with HIV/AIDS. J Gen Intern Med. 2000;15(10):731–8.
Andersen M, Hockman E, Smereck G, et al. Retaining women in HIV medical care. J Assoc Nurses AIDS Care. 2007;18(3):33–41.
Mugavero MJ, Norton WE, Saag MS. Health care system and policy factors influencing engagement in HIV medical care: piecing together the fragments of a fractured health care Delivery System. Clin Infect Dis. 2011;52 Suppl 2:S238–46.
Giordano TP. Retention in HIV care: what the clinician needs to know. Top Antivir Med. 2011;19(1):12–6.
DeLuca JB, Mullins MM, Lyles CM, Crepaz N, Kay L, Thadiparthi S. Developing a comprehensive search strategy for evidence-based systematic review. Evid Based Libr Inf Pract. 2008;3(1):3–32.
Horstmann E, Brown J, Islam F, Buck J, Agins BD. Retaining HIV-infected patients in care: where are we? where do we go from here? Clin Infect Dis. 2010;50(5):752–61.
Mugavero MJ, Davila JA, Nevin CR, Giordano TP. From access to engagement: measuring retention in outpatient HIV clinical care. AIDS Patient Care STDS. 2010;24(10):607–13.
Gardner LI, Metsch LR, Anderson-Mahoney P, et al. Efficacy of a brief case management intervention to link recently diagnosed HIV-infected persons to care. AIDS. 2005;19(4):423–31.
Naar-King S, Bradford J, Coleman S, Green-Jones M, Cabral H, Tobias C. Retention in care of persons newly diagnosed with HIV: outcomes of the Outreach Initiative. AIDS Patient Care STDS. 2007;21 Suppl 1:S40–8.
Bradford JB, Coleman S, Cunningham W. HIV System Navigation: an emerging model to improve HIV care access. AIDS Patient Care STDS. 2007;21 Suppl 1:S49–58.
Hightow-Weidman LB, Smith JC, Valera E, Matthews DD, Lyons P. Keeping them in “STYLE”: finding, linking, and retaining young HIV-positive black and Latino men who have sex with men in care. AIDS Patient Care STDS. 2011;25(1):37–45.
Wohl AR, Garland WH, Wu J, et al. A youth-focused case management intervention to engage and retain young gay men of color in HIV care. AIDS Care. 2011;23(8):988–97.
Gardner L, Marks G, Craw J et al. A low-effort clinic-wide intervention improves attendance for HIV primary care. Clin Infect Dis. In press 2012.
Naar-King S, Outlaw A, Green-Jones M, Wright K, Parsons JT. Motivational interviewing by peer outreach workers: a pilot randomized clinical trial to retain adolescents and young adults in HIV care. AIDS Care. 2009;21(7):868–73.
Davila JA, Miertschin N, Sansgiry S, Schwarzwald H, Henley C, Giordano TP. Centralization of HIV services in HIV-positive African-American and Hispanic youth improves retention in care. AIDS Care. In press 2012.
Enriquez M, Farnan R, Cheng AL, et al. Impact of a bilingual/bicultural care team on HIV-related health outcomes. J Assoc Nurses AIDS Care. 2008;19(4):295–301.
Purcell DW, Latka MH, Metsch LR, et al. Results from a randomized controlled trial of a peer-mentoring intervention to reduce HIV transmission and increase access to care and adherence to HIV medications among HIV-seropositive injection drug users. J Acquir Immune Defic Syndr. 2007;46 Suppl 2:S35–47.
Wolitski RJ, Kidder DP, Pals SL, et al. Randomized trial of the effects of housing assistance on the health and risk behaviors of homeless and unstably housed people living with HIV. AIDS Behav. 2010;14(3):493–503.
Zinski A, Wahl T, Mugavero M. Peer interventions for adherence to HIV clinical care: a systematic review. Oral presentation at: IAPAC 6th International Conference on HIV Treatment and Prevention Adherence; May 22-24, 2011; Miami, FL. Abstract 69909.
Konkle-Parker D, Amico KR, McKinney V. A multi-dimensional intervention imporves retention to HIV care. Poster presented at: IAPAC 7th International Conference on HIV Treatment and Prevention Adherence; June 3-5, 2012; Miami, FL. Abstract 79991.
Gardner L, Marks G, Craw J et al. Preliminary findings from CDC/HRSA retention in care project. Oral presentation at: IAPAC 7th International Conference on HIV Treatment and Prevention Adherence. June 3-5, 2012; Miami, FL. Available at:
. Accessed June 29, 2012.
• Thompson MA, Mugavero MJ, Amico KR, et al. Guidelines for improving entry into and retention in care and antiretroviral adherence for persons with HIV: evidence-based recommendations from an International Association of Physicians in AIDS Care Panel. Ann Intern Med. 2012;156(11):817–33.
Recommendations are offered for monitoring entry and retention in HIV care and for intervening to improve these outcomes
Mugavero M, Westfall A, Zinski A et al. Measuring retention in HIV care: the elusive gold standard. Oral presentation at: IAPAC 7th International Conference on HIV Treatment and Prevention Adherence; June 3-5, 2012; Miami, FL. Abstract 79956.
© Springer Science+Business Media, LLC (outside the USA) 2012