Lessons Learned from the SPNS Outreach Project to Engage and Retain People in HIV Medical Care

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Lessons Learned from the SPNS Outreach Project to
Engage and Retain People in HIV Medical Care

• Implications for Engagement and Retention in HIV
  Oral Health Care
• Carol Tobias, Boston University School of Public
  Health, August 30, 2006

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Overview of the Initiative

• 5 year HRSA SPNS demonstration project to engage
  and retain underserved populations in HIV care
• 17 programs funded to evaluate existing outreach
  interventions for 2 years
• 10 programs funded to enhance interventions and
  evaluate for 3 years

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Major findings

• 1133 people enrolled in longitudinal study at 10
  program sites
• 3 at risk populations
• Not in care at all (small group)
• Tenuously connected
• At high risk of dropping out of care

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Profile of clients enrolled in interventions and
the study

• 85 people of color
• 11 primary language is Spanish
• 38 female
• ¼ had history of hospitalization for mental
  illness ½ in MH treatment
• 2/3 unstably housed
• 2/3 with history of cocaine use

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Outcomes at 12 Months (N722)
All statistically significant _at_plt.001
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Unmet needs at Intake
Note Sample size 1129-1133 for all needs
except dental. Dental sample 847
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Factors associated with unmet dental needs in
bivariate analysis

• Unstable housing
• More recent diagnosis
• Less engaged in medical care
• Poorer physical health (SF-12)
• Poorer mental health (SF-12)
• Drug/alcohol use in past 30 days

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Other factors..

• Practical barriers to care
• Concerns about people finding out
• HIV status
• Sexual orientation
• Drug use
• Health beliefs
• Other unmet needs

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Factors NOT associated with unmet dental needs

• Age
• Gender
• Education
• Sexual orientation
• CD4 count

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What helped people get into care?
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Models that worked

• Health systems navigation
• Clinic-based
• Community-based
• Enhanced case management
• Intensive accompaniment models
• Case management added to outreach
• Peer support

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Interventions that worked

• Tracking missed appointments for outreach
  interventions
• Motivational interviewing
• Health literacy
• Life skills training
• Interagency connections