HIV treatment retention and re-engagement of individuals lost to care are of increasing concern. Nearly 50% of individuals in treatment for HIV drop out of care (Grimes et al., 2016). These individuals are more likely to come from disadvantaged/underserved backgrounds and to experience difficulties across several life domains that make treatment engagement challenging (Muthulingam et al., 2013). In Hawai‘i, Native Hawaiians are especially vulnerable to dropping from treatment and social disadvantage (Sentell et al., 2014). Given these intersecting difficulties, a wrap-around service model may be effective in increasing re-engagement in treatment, particularly in Hawai‘i. This study investigated the effectiveness of such an approach. This poster presents the preliminary results of an ongoing mixed methods investigation of a novel case management intervention, called Treatment as Prevention (TasP), aimed at re-engaging HIV-positive, non-virally suppressed individuals living on O‘ahu. These findings suggest that collaborative, wrap-around efforts initiated by clinicians, researchers, and community-based care partners increase individual re-engagement and may lead to improved overall HIV care and second-order change.
Our study included program participants (n=25) with chronically detectable viral loads (VL > 200) and a history of difficulty engaging in HIV treatment (or were at risk of falling out of treatment). These individuals were transferred from traditional case management (with caseloads over 100) to the intensive, strength-based case management program (caseloads capped at 25). Study staff surveyed and interviewed program participants at baseline and then every other month. The survey assessed health-related quality of life, barriers to care, access to healthcare, housing, social support, and community engagement. Interviews were transcribed and coded thematically.
Preliminary findings suggest that individuals receiving case management support addressing ancillary needs (e.g., housing, employment, transportation, social support, and mental health) demonstrated increased likelihood of returning to HIV treatment. Early findings also suggest that increased time per individual and the person-centered approach of the case manager were integral elements to re-engagement. Further, we found that collectively recruited efforts across the full system of care through wrap-around services was essential for effective support.
This study provided early evidence that interventions that lend support to individuals across meaningful life domains and engage multiple care providers into a coordinated network may be effective in re-engaging individuals previously lost to care.