May 31, 2013
The International AIDS Society journal AIDS has reported that New York City (NYC) public health officials launched an effective program to locate HIV-positive patients who were "lost to follow-up" and reconnected them to treatment services. The study, authored by Chi-Chi N. Udeagu, MPH, and colleagues of the NYC Department of Health and Mental Hygiene, emphasized that restarting antiretroviral therapy is particularly significant with the current emphasis on HIV "treatment-as-prevention." The article is available on the AIDS journal homepage and will appear in the June 12 print edition.
City public health officials used the NYC HIV surveillance registry to find patients who had tested HIV-positive earlier but did not have current information on routine laboratory test results. Public health case workers made intensive efforts by mail, home visits, telephone calls, and Internet searches to contact the "lost to follow-up" patients. Once they found the patients, health officials offered them help and urged them to restart HIV care and re-establish treatment services. The officials also asked patients to identify sexual partners who might be at risk for HIV. Case workers located 689 out of 797 patients believed to be lost to follow-up. Health officials learned that 33 percent of patients were up-to-date with HIV treatment, but either the database had not recorded their latest lab results yet or the health department did not require the HIV medical providers the patients had visited -- such as HIV clinical trial units and veterans hospitals -- to report lab results. Five percent of located patients were incarcerated or had moved, and two percent had died. Health officials located and verified that 409 patients were not 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.
Overall, the program succeeded in identifying approximately half of the initial patients listed as being lost to follow-up and in re-engaging most of them with treatment services. Approximately half of patients lost to follow-up agreed to be interviewed for partner services. These efforts resulted in identifying three new HIV-infection diagnoses.
The full report, "Lost -- or Just Not Following Up? Public Health Effort to Re-Engage HIV-Infected Persons Lost to Follow-Up Into HIV Medical Care," was published in the journal AIDS (2013; 108 (120)).