December 18, 2019
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Text reminders, stigma support boost retention in HIV care

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Patients who receive HIV care at clinics that offer text message appointment reminders and stigma support services, such as mental health providers and onsite social workers, are around 10% more likely to be retained in care than patients who use clinics that do not offer these services, recent study findings suggest.

Retention in HIV care leads to reduced HIV transmission and mortality,” Cassandra D. Oliver, MPH, a PhD student in epidemiology at Vanderbilt University Medical Center, told Healio. “There are few studies assessing how the availability of services at the clinical site level affects retention in HIV care across multiple clinics serving a large and diverse population of people living with HIV in the United States.”

The study by Oliver and colleagues included 21,046 people living with HIV — contributing 103,348 person-years — with at least one HIV primary care visit from 2010 to 2016 at one of seven sites in the Center for AIDS Research Network of Integrated Clinical Systems.

According to the study, the researchers gathered data on the clinics through a survey that included questions about site characteristics and services, such as peer navigation; the presence of retention in care posters and brochures; laboratory test timing; flexible scheduling; appointment reminder types; and stigma support services.

Results showed that, overall, 67% of person-years were retained in care. Researchers found that the availability of text appointment reminders (incident rate ratio [IRR] = 1.13; 95% CI, 1.03-1.24) and stigma support services (IRR = 1.11; 95% CI, 1.04-1.19) — including counseling through trained onsite social workers and mental health providers — were associated with better retention in care.

“The availability of text appointment reminders and HIV stigma support services at HIV clinical care sites in the U.S. may improve retention in HIV care,” Oliver said. “However, prospective studies evaluating the association of an individual patient’s utilization of these services (vs. availability of the services at the clinical site) with retention in care are needed.”

According to Oliver, the cost for text appointment reminders depends on the vendor providing the services and the frequency and type of the messages, such as one-way vs. two-way messages. She said some electronic health record systems include the technical capacity to provide a text message reminder. The cost of stigma support services depends on the training level of the staff member providing the services, as well as the frequency and duration of the services, she said.

“Clinicians can lobby their clinical administration to invest in these services or apply for grant funding to support these services,” Oliver suggested. “An alternative way to address stigma includes educational HIV training for clinical staff in order to reduce discrimination and bias.” – by Caitlyn Stulpin

Disclosures: Oliver reports no relevant financial disclosures. Please see the full study for all other authors’ relevant financial disclosures.