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Challenges in the Evaluation of Interventions to Improve Engagement Along the HIV Care Continuum in the United States: A Systematic Review

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Abstract

In the United States (US), there are high levels of disengagement along the HIV care continuum. We sought to characterize the heterogeneity in research studies and interventions to improve care engagement among people living with diagnosed HIV infection. We performed a systematic literature search for interventions to improve HIV linkage to care, retention in care, reengagement in care and adherence to antiretroviral therapy (ART) in the US published from 2007-mid 2015. Study designs and outcomes were allowed to vary in included studies. We grouped interventions into categories, target populations, and whether results were significantly improved. We identified 152 studies, 7 (5%) linkage studies, 33 (22%) retention studies, 4 (3%) reengagement studies, and 117 (77%) adherence studies. ‘Linkage’ studies utilized 11 different outcome definitions, while ‘retention’ studies utilized 39, with very little consistency in effect measurements. The majority (59%) of studies reported significantly improved outcomes, but this proportion and corresponding effect sizes varied substantially across study categories. This review highlights a paucity of assessments of linkage and reengagement interventions; limited generalizability of results; and substantial heterogeneity in intervention types, outcome definitions, and effect measures. In order to make strides against the HIV epidemic in the US, care continuum research must be improved and benchmarked against an integrated, comprehensive framework.

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Acknowledgements

This work was supported by Cooperative Agreement Number 5U38PS004646 by the National Center for HIV, Viral Hepatitis, STD and TB Prevention (NCHHSTP), Centers for Disease Control and Prevention, as part of the NCHHSTP Epidemiologic and Economic Modeling Cooperative Agreement. Its contents are solely the responsibility of the authors and do not necessarily represent the official views of the Centers for Disease Control and Prevention or the Department of Health and Human Services. The authors would like to thank the Applied Public Health Advisory Group, a collaborative set of state and local public health professionals convened for this project, for their guidance and expertise. We would like to specifically thank Dr. Greg Felzein, Thomas Betrand, Nanette Benbow, Dr. Jane Kelly, Dr. David Holtgrave and Dr. Jim Curran for reviewing this paper and providing feedback.

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  1. Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, 615N. Wolfe St, W6604, Baltimore, MD, 20205, USA

    Kathryn A. Risher, Kate Shearer & David Dowdy

  2. Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, MD, USA

    Sunaina Kapoor & Maunank Shah

  3. Department of Epidemiology, Emory University Rollins School of Public Health, Atlanta, GA, USA

    Alice Moji Daramola, Eli Rosenberg & Patrick Sullivan

  4. Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA

    Gabriela Paz-Bailey, Jacek Skarbinski & Kate Doyle

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Risher, K.A., Kapoor, S., Daramola, A.M. et al. Challenges in the Evaluation of Interventions to Improve Engagement Along the HIV Care Continuum in the United States: A Systematic Review. AIDS Behav 21, 2101–2123 (2017). https://doi.org/10.1007/s10461-017-1687-8

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