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Assessing efficacy of a retention-in-care intervention among HIV patients with depression, anxiety, heavy alcohol consumption and illicit drug use

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Objective:

We evaluated whether heavy alcohol use, illicit drug use or high levels of anxiety, and depression symptoms were modifiers of the retention through enhanced personal contact intervention. The intervention had previously demonstrated overall efficacy in the parent study.

Design:

Randomized trial.Methods:

A total of 1838 patients from six US HIV clinics were enrolled into a randomized trial in which intervention patients received an ‘enhanced contact’ protocol for 12 months. All participants completed an audio computer-assisted self-interview that measured depression and anxiety symptoms from the Brief Symptom Inventory, alcohol use from the Alcohol Use Disorders Identification Test-Consumption instrument, and drug use from the WHO (Alcohol, Smoking and Substance Involvement Screening Test) questions. The 12-month binary outcome was completing an HIV primary care visit in three consecutive 4-month intervals. The outcome was compared between intervention and standard of care patients within subgroups on the effect modifier variables using log-binomial regression models.
Results:

Persons with high levels of anxiety or depression symptoms and those reporting illicit drug use, or heavy alcohol consumption had no response to the intervention. Patients without these ‘higher risk’ characteristics responded significantly to the intervention. Further analysis revealed higher risk patients were less likely to have successfully received the telephone contact component of the intervention. Among higher risk patients who did successfully receive this component, the intervention effect was significant.
Conclusion:

Our findings suggest that clinic-based retention-in-care interventions are able to have significant effects on HIV patients with common behavioral health issues, but the design of those interventions should assure successful delivery of intervention components to increase effectiveness.
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Keywords: alcohol; behavioral intervention trial; depression and anxiety in HIV patients; drug abuse; retention-in-care intervention

Document Type: Research Article

Affiliations: 1: Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia 2: Department of Medicine, Baylor College of Medicine, Center for Innovations in Quality, Effectiveness, and Safety, Michael E. DeBakey VA Medical Center, Department of Psychiatry, University of Texas at Houston School of Medicine, Houston 3: Department of Medicine, Baylor College of Medicine, Medical Director of HIV Services, Thomas Street Health Center and Harris Health System, Center for Innovations in Quality, Effectiveness, and Safety, Michael E. DeBakey VA Medical Center, Houston, Texas 4: Department of Community Health Sciences School of Public Health, State University of New York, Downstate Medical Center, Brooklyn, New York 5: Department of Health Policy and Management, Boston University School of Public Health, Center for Healthcare Organization and Implementation Research, Edith Nourse Rogers Memorial VA Hospital, Department of Medicine, Boston University School of Medicine, Boston, Massachusetts 6: Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland 7: Research and Informatics Service Center (RISC), University of Alabama-Birmingham, Birmingham, Alabama 8: Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, USA.

Publication date: April 24, 2016

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