New York City successfully locates HIV-positive patients 'lost to follow-up'

May 30, 2013, Wolters Kluwer Health

Public health officials in New York City have launched a successful program to locate HIV-positive patients who have been "lost to follow-up" and reconnect them with treatment services, reports a study published in AIDS, official journal of the International AIDS Society.

Efforts to restart antiretroviral therapy are especially important with the current emphasis on "treatment-as-prevention" for HIV, according to the study by Chi-Chi N. Udeagu, MPH, and colleagues of the New York City Department of Health and Mental Hygiene. The article is available on the AIDS journal homepage and in the June 12 print edition.

Effort to Locate HIV Patients Lost to Follow-Up …

The program used the NYC HIV surveillance registry to identify patients who had previously tested positive for HIV but did not have current information on routine laboratory test results. Public health case workers made intensive efforts—including phone calls, mail, home visits, and Internet searches— to contact this group of "lost to follow-up" patients.

Once located, patients were offered help in re-engaging with treatment services and restarting HIV care. They were also targeted for efforts to identify sexual partners who might be at risk of HIV.

Case workers were able to locate 689 out of 797 patients presumed lost to follow-up. After being contacted, 33 percent of patients were found to be up-to-date with —their most recent lab results were not yet reported in the database, or they were seen by HIV medical providers not required to report lab results to the health department, such as Veterans hospitals and HIV clinical trial units. Five percent of located patients had moved or were incarcerated, while two percent had died.

This left 409 patients who were successfully located and verified as not being up-to-date with HIV care. Once located, 77 percent of these patients accepted an appointment at an HIV clinic and 57 percent returned to treatment.

…Leads Most to Re-Engage with Treatment Services

Overall, the program was successful in identifying about half of the initial list of patients as being lost to follow-up, and in re-rengaging most of them with treatment services. About half of patients lost to follow-up agreed to be interviewed for partner services. These efforts led to identification and a new diagnosis of HIV infection in three patients.

When patients were asked why they stopped attending HIV care, about 40 percent said they felt well and didn't think they needed treatment. Other reasons included day-to-day responsibilities, not trusting health care workers, side effects of HIV medicines, feeling depressed, being uninsured, and not wanting to think about being HIV-positive.

Recent years have seen a growing emphasis on "treatment-as-prevention" of HIV—giving antiretroviral medications to lower the viral load, which significantly reduces the risk of transmitting the infection. Most studies of this approach have focused on patients newly diagnosed with HIV. But it's just as important to focus efforts on patients with previously diagnosed HIV who are "un-engaged or under-engaged" in HIV medical care.

The public health effort reported in the study would not have been possible without the NYC HIV surveillance registry, which was used to identify patients ""lost to follow-up", and monitor their outcomes following re-engagement efforts. The fact that one-third of located patients actually were current with care probably reflects lag times in reporting lab test results to the registry.

Based on their results, Udeagu and coauthors conclude, "HIV surveillance data can and should be used by health departments to identify and locate people living with HIV who are lost to follow-up, and case-workers should investigate such cases with the goal of re-engaging such [] in medical care for HIV." They add, "Although challenges abound, such efforts are essential to any comprehensive effort to control the HIV epidemic."

Explore further: HIV no barrier to getting liver transplant, study finds

Related Stories

HIV no barrier to getting liver transplant, study finds

May 17, 2013
(HealthDay)—Liver transplants to treat a common type of liver cancer are a viable option for people infected with HIV, according to new research.

Integrating mental health care into HIV care

May 21, 2013
The integration of mental health interventions into HIV prevention and treatment platforms can reduce the opportunity costs of care and improve treatment outcomes, argues a new Policy Forum article published in this week's ...

Peer-referral programs can increase HIV-testing in emergency departments

May 17, 2013
Researchers at the University of Cincinnati (UC) have found that incorporating a peer-referral program for HIV testing into emergency departments can reach new groups of high-risk patients and brings more patients into the ...

HIV patients in care lose more years of life to smoking than to HIV infection

December 19, 2012
Among HIV patients receiving well-organized care with free access to antiretroviral therapy, those who smoke lose more years of life to smoking than to HIV, according to a Danish study published in Clinical Infectious Diseases ...

Brazil to begin tracking numbers of HIV cases

December 27, 2012
(AP)—Brazilian health officials say doctors will be required to notify authorities of every HIV case in the nation.

Gender, race, and HIV therapy: Insights from the GRACE study

May 30, 2013
Enrollment of women in clinical trials of new anti-HIV drugs is extremely low, representing only about 15% of all treatment-experienced patients. For women of color it is even lower. Why women, and especially women of color, ...

Recommended for you

HIV-1 genetic diversity is higher in vaginal tract than in blood during early infection

January 18, 2018
A first-of-its-kind study has found that the genetic diversity of human immunodeficiency virus type 1 (HIV-1) is higher in the vaginal tract than in the blood stream during early infection. This finding, published in PLOS ...

War in Ukraine has escalated HIV spread in the country: study

January 15, 2018
Conflict in Ukraine has increased the risk of HIV outbreaks throughout the country as displaced HIV-infected people move from war-affected regions to areas with higher risk of transmission, according to analysis by scientists.

Researchers offer new model for uncovering true HIV mortality rates in Zambia

January 12, 2018
A new study that seeks to better ascertain HIV mortality rates in Zambia could provide a model for improved national and regional surveillance approaches, and ultimately, more effective HIV treatment strategies.

New drug capsule may allow weekly HIV treatment

January 9, 2018
Researchers at MIT and Brigham and Women's Hospital have developed a capsule that can deliver a week's worth of HIV drugs in a single dose. This advance could make it much easier for patients to adhere to the strict schedule ...

New long-acting, less-toxic HIV drug suppresses virus in humanized mice

January 8, 2018
A team of Yale researchers tested a new chemical compound that suppresses HIV, protects immune cells, and remains effective for weeks with a single dose. In animal experiments, the compound proved to be a promising new candidate ...

Usage remains low for pill that can prevent HIV infection

January 8, 2018
From gritty neighborhoods in New York and Los Angeles to clinics in Kenya and Brazil, health workers are trying to popularize a pill that has proven highly effective in preventing HIV but which—in their view—remains woefully ...

0 comments

Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.