Background In mid-2016, the BC HIV Drug Treatment Program (DTP) expanded its province-wide prescriber alert system for ART interruptions to include direct referrals to public health offices for persons off treatment for >4 months. We examined outcomes before and after launch of this Re-Engagement and Engagement in Treatment for Antiretroviral Interrupted and Naïve populations (RETAIN) Initiative.
Methods We analyzed adult, DTP participants with ART interruptions triggering a physician-directed alert (ART refill >2 months late) in pre-RETAIN (Jul-2013 to Apr-2016) and post-RETAIN (May-2016 to Oct-2017) periods, based on the first alert issued within the study period. Follow-up continued until Oct-2018, excluding persons who moved or died within 90 days of an alert being sent. We compared the proportion of persons who were linked to care, re-started ART, or achieved viral suppression in the pre- and post-RETAIN periods, and the time to ART re-initiation using a generalized estimating equation model.
Results There were 3219 alerts sent for 1805 patients, 1374 related to first interruptions in the pre-RETAIN period and 431 post-RETAIN. Of these, 135/431 (31%) post-RETAIN cases were referred to public health within 4 months following the first alert. Patients were predominantly male (74%) with a median age of 47 years. We found no statistically significant differences in the proportions of persons who were linked to care (83% vs 83%), re-started ART within 4 months (73% vs 74%), or achieved viral suppression (61% vs 62%) between the two periods. Among persons who re-initiated ART >4 months following the initial alert, the median (Q1-Q3) time to ART restart declined significantly from 9 (6–15) months pre-RETAIN to 8 (6–11) months post-RETAIN (p=0.004), possibly influenced by public health intervention.
Conclusion We observed shorter time to re-initiation after the introduction of referrals for public health support. Similar systems could be considered in other jurisdictions.
Disclosure No significant relationships.
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