Study Overview

Investigation Team

Dr Joseph Cox 

Dr Nadine Kronfli

Chronic Viral Illness Service
McGill University Health Centre

Montreal
Canada

Co-investigators
Dr Bertrand Lebouché
Dr Kim Engler

Research Coordinator
Blake Linthwaite

Proposed finish date
1 July 2020

HIV Care Continuum stages covered (3)

Lost & Found is a pilot study evaluating implementation of a nurse-led intervention to re-engage loss to follow-up patients into HIV care. It takes place at the Chronic Viral Illness Service, McGill University Health Centre, Montreal, Canada. 

The goal of this pilot study is to evaluate the implementation and effectiveness of a clinic-based intervention to re-engage HIV-positive patients into care. This study relates to the second and third of the 90-90-90 objectives set out by UNAIDS. 

At the Chronic Viral Illness Service, 10% of active HIV positive patients in 2015 did not have any clinical follow-up in 2016. The negative health impacts associated with disengagement from care, including reduced adherence to cART, virologic failure, development of resistance, secondary HIV transmission, and increased hospitalisation costs and mortality, mean that there is an urgent need for intervention. These patients need to be identified and should be prioritised for re-engagement in care. This must be done in a feasible and appropriate way that is effective in a high-volume clinical setting.

Currently, no formal system exists to re-engage and retain these patients in care. Furthermore, little is known regarding the sociodemographic, psychosocial and clinical care correlates of patients with care interruptions. Lost & Found is a nurse-led intervention developed using an implementation science approach by our own team of nurses, clinician-researchers, and a research coordinator at the McGill University Health Centre. 

 

1 Primary objective

To assess nurse-related implementation outcomes (acceptability, feasibility, fidelity and adoption) and implementation determinants, to evaluate implementation of the intervention.

2 Secondary objective

To assess the effectiveness of the intervention by determining the proportion of loss to follow-up patients who are re-engaged in care over a one-year period.

3 Tertiary objective

To determine the sociodemographic, psychosocial, and clinical characteristics of loss to follow-up patients who re-engage in care, and to assess related acceptability and feasibility of the intervention.

This single-arm, prospective pilot study will follow a type II implementation-effectiveness hybrid structure:

For this study, both nurses and patients are participants. We estiamte that approximately 25 patients will be identified as lost to follow-up per month. The implementation phase began in March 2018 and the intervention will be offered for one year.

01.  

Pre-implementation: the study team developed the lost to follow-up risk prediction tool, and trained nurses how to use it.

Using clinical characteristics and time since last visit data, each patient is given a risk level for poor health outcomes. In conjunction with clinical judgement, this risk level helps nurses determine patient need and priority for re-engagement.

02.  

Implementation: the study team supports nurses to use the lost to follow-up risk prediction tool and in-tracking activities to re-engage patients into care.

Nurses make calls to patients to book them into care within an appropriate time frame according to their risk score. Attempts to re-engage unreachable patients will be made for up to six months.

Conclusion

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Limitations

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