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Randomized Trial of a Health Coaching Intervention to Enhance Retention in Care: California Collaborative Treatment Group 594

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Abstract

Poor linkage, engagement and retention remain significant barriers in achieving HIV treatment goals in the US. HIV-infected persons entering or re-entering care across three Southern California academic HIV clinics, were randomized (1:1) to an Active, Linkage, Engagement, Retention and Treatment (ALERT) specialist for outreach and health coaching, or standard of care (SOC). The primary outcome of time to loss to follow up (LTFU) was compared using Cox proportional hazards regression modeling. No differences in the median time to LTFU (81.7 for ALERT versus 93.6 weeks for SOC; HR 1.27; p = 0.40), or time to ART initiation was observed (N = 116). Although, ALERT participants demonstrated worsening depressive symptomatology from baseline to week 48 compared to SOC (p = 0.02). The ALERT intervention did not improve engagement and retention in HIV care over SOC. Further studies are needed to determine how best to apply resources to improve retention and engagement.

Resumen

Pobre vinculación, la participación activa con el cuidado médico y la retención siguen siendo barreras significantes para lograr los objetivos de tratamiento del VIH en los Estados Unidos. Las personas infectadas por el VIH que ingresan o reingresan a la atención medica en tres clínicas académicas de VIH del sur de California, aleatorizado (1:1) a un Active, Linkage, Engagement, Retention and Treatment (ALERT) especialista para alcance y educación de salud, o estándar de atención (SOC). Se comparó el resultado primario del tiempo hasta la pérdida de seguimiento (LTFU) usando modelado de regresión de riesgos proporcionales Cox. No hubo diferencias en el tiempo mediano para LTFU (81,7 para ALERT versus 93,6 semanas para SOC; HR: 1.27; p = 0.40), tampoco en el tiempo de iniciación los medicamentos del VIH (N = 116). Los participantes en el grupo de ALERT demostraron un empeoramiento de la sintomatología depresiva relativo a la línea basal hasta la semana 48 comparado al SOC (p = 0.02). La intervención ALERT no mejoro la participación activa y la retención en el cuidado del VIH sobre el SOC. Se necesita estudios adicionales para determinar la mejor manera de aplicar recursos para mejorar la retención y la participación activa.

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Funding

This work was funded by the California HIV Research Program fund El11-SD-005. Consent from all co-authors listed in this paper was received prior to submitting for review.

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Authors and Affiliations

  1. Department of Medicine, Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center and the David Geffen School of Medicine at UCLA, 1124 West Carson Street, Building CDCRC, Box 496, Torrance, CA, 90502, USA

    Katya Corado & Eric S. Daar

  2. Deparment of Family and Preventive Medicine, University California San Diego, San Diego, CA, USA

    Sonia Jain, Sheldon Morris & Feng He

  3. Department of Medicine, Keck School of Medicine of the University Southern California, Los Angeles, CA, USA

    Michael P. Dube

  4. San Ysidro Health Center, San Ysidro, CA, USA

    Jeannette L. Aldous

  5. Deparment of Medicine, University California San Diego, San Diego, CA, USA

    Amy Sitapati & Maile Young Karris

  6. Gilead Sciences, Foster City, CA, USA

    Richard Haubrich

  7. Department of Preventive Medicine, Keck School of Medicine of the University Southern California, Los Angeles, CA, USA

    Joel Milam

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  1. Katya Corado
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  2. Sonia Jain
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  3. Sheldon Morris
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  6. Feng He
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  10. Joel Milam
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  11. Maile Young Karris
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Correspondence to Katya Corado.

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Conflicts of interest

KC has received research support from Gilead and ViiV. MPD has served as a consultant to Gilead, Theratec, and Astra Zeneca and receives research support through his university from GileaMerck, Theratec, and ViiV. ESD has received research support from Gilead, Merck and ViiV as well as being a consultant/advisor for Bristol Myers Squibb, Gilead, Janssen, Merck, Teva, Theratechnology and ViiV. RH is an employee of Gilead Sciences. MK has served on an Advisory Board and receives funding to the institution from Gilead Sciences. Her other sources of funding come in part by the National Institutes of Health [R24AG044325, R01MH110057] and she is supported by the University of California San Diego Center For AIDS Research (CFAR) a NIH-funded program (P30 AI036214).

Ethical Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards and approved by the institutional research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Informed consent was obtained from all individuals participants included in the study.

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Joel Milam and Maile Young Karris are Co-last authors.

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Corado, K., Jain, S., Morris, S. et al. Randomized Trial of a Health Coaching Intervention to Enhance Retention in Care: California Collaborative Treatment Group 594. AIDS Behav 22, 2698–2710 (2018). https://doi.org/10.1007/s10461-018-2132-3

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