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Shrestha RK, Galindo C, Courtenay-Quirk C, Harshbarger C, Abdallah I, Marconi VC, Dalla Piazza M, Swaminathan S, Somboonwit C, Lewis MA, Khavjou OA. Cost Analysis of the Positive Health Check Intervention to Suppress HIV Viral Load and Retain Patients in HIV Clinical Care. JOURNAL OF PUBLIC HEALTH MANAGEMENT AND PRACTICE 2023; 29:326-335. [PMID: 36867503 PMCID: PMC10152339 DOI: 10.1097/phh.0000000000001695] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/04/2023]
Abstract
CONTEXT Digital video-based behavioral interventions are effective tools for improving HIV care and treatment outcomes. OBJECTIVE To assess the costs of the Positive Health Check (PHC) intervention delivered in HIV primary care settings. DESIGN, SETTING, AND INTERVENTION The PHC study was a randomized trial evaluating the effectiveness of a highly tailored, interactive video-counseling intervention delivered in 4 HIV care clinics in the United States in improving viral suppression and retention in care. Eligible patients were randomized to either the PHC intervention or the control arm. Control arm participants received standard of care (SOC), and intervention arm participants received SOC plus PHC. The intervention was delivered on computer tablets in the clinic waiting rooms. The PHC intervention improved viral suppression among male participants. A microcosting approach was used to assess the program costs, including labor hours, materials and supplies, equipment, and office overhead. PARTICIPANTS Persons with HIV infection, receiving care in participating clinics. MAIN OUTCOME MEASURES The primary outcome was the number of patients virally suppressed, defined as having fewer than 200 copies/mL by the end of their 12-month follow-up. RESULTS A total of 397 (range across sites [range], 95-102) participants were enrolled in the PHC intervention arm, of whom 368 participants (range, 82-98) had viral load data at baseline and were included in the viral load analyses. Of those, 210 (range, 41-63) patients were virally suppressed at the end of their 12-month follow-up visit. The overall annual program cost was $402 274 (range, $65 581-$124 629). We estimated the average program cost per patient at $1013 (range, $649-$1259) and the cost per patient virally suppressed at $1916 (range, $1041-$3040). Recruitment and outreach costs accounted for 30% of PHC program costs. CONCLUSIONS The costs of this interactive video-counseling intervention are comparable with other retention in care or reengagement interventions.
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Affiliation(s)
- Ram K. Shrestha
- Division of HIV Prevention, National Center for HIV, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Carla Galindo
- Division of HIV Prevention, National Center for HIV, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Cari Courtenay-Quirk
- Division of HIV Prevention, National Center for HIV, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Camilla Harshbarger
- Division of HIV Prevention, National Center for HIV, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia
| | | | - Vincent C. Marconi
- Division of Infectious Diseases, Emory University School of Medicine, Emory Vaccine Center, and Rollins School of Public Health, Atlanta, Georgia; Atlanta VA Medical Center, Decatur, Georgia
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Galindo CA, Freeman A, Abdallah I, Courtenay-Quirk C. Positive Health Check intervention tool usage during a feasibility pilot in HIV primary care clinics. AIDS Care 2023; 35:35-40. [PMID: 35765161 DOI: 10.1080/09540121.2022.2094311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Positive Health Check (PHC), an interactive, web-based intervention, provides tailored behavioral health messages to support people with HIV in their HIV care. Users interact with a virtual doctor and based on responses to tailoring questions, PHC delivers relevant content modules addressing treatment initiation, medication adherence, retention in care, sexual risk reduction, mother-to-child transmission, and injection drug use. During a one-month feasibility pilot of PHC, patients in four HIV primary care clinics were invited to use PHC and tool usage metrics were collected and assessed. Descriptive analyses were conducted to characterize how the tool was used based on behavioral risk scenarios presented.Ninety-seven patients accessed PHC as part of the pilot, with 68 (70.1%) completing the intervention on average in 15 min. Out of 85 patients who viewed behavioral tips and commitments, 66 (77.7%) selected at least one tip to practice and 41 (48.2%) made at least one commitment to ask their provider a question. Patients spent the most time with adherence and sexual risk reduction content. The high level of tool engagement suggests that PHC was acceptable to patients regardless of length of time since diagnosis. PHC can be completed within a single visit and is a promising tool for PWH.
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Affiliation(s)
- Carla A Galindo
- Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Arin Freeman
- Centers for Disease Control and Prevention, Atlanta, GA, USA
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Albouy M, Parthenay M, Nogues M, Leyris A, Degorce L, Barthelemy Z, Rafidison D, Gourgues AS, Migeot V, Pylouster J, Dupuis A. A Clinical Preventive Strategy Based on a Digital Tool to Improve Access to Endocrine Disruptors Exposure Prevention: The MEDPREVED Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:11993. [PMID: 36231296 PMCID: PMC9565443 DOI: 10.3390/ijerph191911993] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Revised: 09/15/2022] [Accepted: 09/16/2022] [Indexed: 06/16/2023]
Abstract
Introduction: The digitalized PREVED (PREgnancy, PreVention, Endocrine Disruptor) questionnaire was used in the clinical practices of health professionals (HP) who adhered to the MEDPREVED strategy. The objectives were to assess the strategy and to determine if it could improve access to endocrine disruptor (ED) exposure prevention. Methods: After having filled in the digital questionnaire in HP waiting rooms, patients were invited to talk about ED exposure during the consultation. HPs were previously trained in ED and had received a prevention kit for their patients. After the seven-month implementation phase, the evaluation phase consisted of five mixed assessments: interviews with: (i) patients who were young children's parents; (ii) patients in the general population; (iii) paediatricians; (iv) midwives; and a quantitative study on GPs. Assessment concerned feasibility, accessibility, and usefulness of the strategy; we then used the Levesque model to evaluate how it could improve access to ED exposure prevention. Results: The study included 69 participants. The strategy appeared feasible for the filling-out step due to digital and environment access. However, it depended on patient and HP profiles. The strategy seemed useful insofar as it facilitated reflexive investment, an intention to healthy behaviour and, rather rarely, talk about ED exposure. The beginning of this discussion depended on time, prioritizing of the topic and HP profile. The strategy has confirmed the Levesque model's limiting factors and levers to access ED prevention. Conclusions: The MEDPREVED strategy is feasible, accessible, and useful in clinical prevention practice. Further study is needed to measure the impact on knowledge, risk perception and behavior of beneficiaries of the MEDPREVED strategy in the medium and long term.
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Affiliation(s)
- Marion Albouy
- Faculty of Medicine and Pharmacy, University of Poitiers, 6 Rue de la Milétrie, 86000 Poitiers, France
- Ecology and Biology of Interaction, CNRS UMR 7267, CEDEX, 86073 Poitiers, France
- INSERM-CIC1402, University Hospital of Poitiers, 2 Rue de la Milétrie, CEDEX, 86021 Poitiers, France
- BioSPharm Pole, University Hospital of Poitiers, 2 Rue de la Milétrie, CEDEX, 86021 Poitiers, France
| | - Maud Parthenay
- Faculty of Medicine and Pharmacy, University of Poitiers, 6 Rue de la Milétrie, 86000 Poitiers, France
| | - Maeva Nogues
- Faculty of Medicine and Pharmacy, University of Poitiers, 6 Rue de la Milétrie, 86000 Poitiers, France
| | - Agathe Leyris
- Faculty of Medicine and Pharmacy, University of Poitiers, 6 Rue de la Milétrie, 86000 Poitiers, France
| | - Léa Degorce
- Faculty of Medicine and Pharmacy, University of Poitiers, 6 Rue de la Milétrie, 86000 Poitiers, France
| | - Zacharie Barthelemy
- Faculty of Medicine and Pharmacy, University of Poitiers, 6 Rue de la Milétrie, 86000 Poitiers, France
| | - Diana Rafidison
- Faculty of Medicine and Pharmacy, University of Poitiers, 6 Rue de la Milétrie, 86000 Poitiers, France
| | - Anne-Sophie Gourgues
- BioSPharm Pole, University Hospital of Poitiers, 2 Rue de la Milétrie, CEDEX, 86021 Poitiers, France
| | - Virginie Migeot
- Faculty of Medicine and Pharmacy, University of Poitiers, 6 Rue de la Milétrie, 86000 Poitiers, France
- Ecology and Biology of Interaction, CNRS UMR 7267, CEDEX, 86073 Poitiers, France
- INSERM-CIC1402, University Hospital of Poitiers, 2 Rue de la Milétrie, CEDEX, 86021 Poitiers, France
- BioSPharm Pole, University Hospital of Poitiers, 2 Rue de la Milétrie, CEDEX, 86021 Poitiers, France
| | - Jean Pylouster
- Research Centre on Cognition and Learning, MSHS, 5 Rue T. Lefebvre, CEDEX, 86073 Poitiers, France
| | - Antoine Dupuis
- Faculty of Medicine and Pharmacy, University of Poitiers, 6 Rue de la Milétrie, 86000 Poitiers, France
- Ecology and Biology of Interaction, CNRS UMR 7267, CEDEX, 86073 Poitiers, France
- INSERM-CIC1402, University Hospital of Poitiers, 2 Rue de la Milétrie, CEDEX, 86021 Poitiers, France
- BioSPharm Pole, University Hospital of Poitiers, 2 Rue de la Milétrie, CEDEX, 86021 Poitiers, France
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Lewis MA, Harshbarger C, Bann C, Marconi VC, Somboonwit C, Piazza MD, Swaminathan S, Burrus O, Galindo C, Borkowf CB, Marks G, Karns S, Zulkiewicz B, Ortiz A, Abdallah I, Garner BR, Courtenay-Quirk C. Effectiveness of an Interactive, Highly Tailored "Video Doctor" Intervention to Suppress Viral Load and Retain Patients With HIV in Clinical Care: A Randomized Clinical Trial. J Acquir Immune Defic Syndr 2022; 91:58-67. [PMID: 35972854 PMCID: PMC9377499 DOI: 10.1097/qai.0000000000003045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Accepted: 05/25/2022] [Indexed: 11/26/2022]
Abstract
BACKGROUND To determine whether Positive Health Check, a highly tailored video doctor intervention, can improve viral suppression and retention in care. SETTING Four clinics that deliver HIV primary care. METHODS A hybrid type 1 effectiveness-implementation randomized trial design was used to test study hypotheses. Participants (N = 799) who were not virally suppressed, were new to care, or had fallen out of care were randomly assigned to receive Positive Health Check or the standard of care alone. The primary endpoint was viral load suppression, and the secondary endpoint was retention in care, both assessed at 12 months, using an intention-to-treat approach. A priori subgroup analyses based on sex assigned at birth and race were examined as well. RESULTS There were no statistically significant differences between Positive Health Check (N = 397) and standard of care (N = 402) for either endpoint. However, statistically significant group differences were identified from a priori subgroup analyses. Male participants receiving Positive Health Check were more likely to achieve suppression at 12 months than male participants receiving standard of care adjusted risk ratio [aRR] [95% confidence interval (CI)] = 1.14 (1.00 to 1.29), P = 0.046}. For retention in care, there was a statistically significant lower risk for a 6-month visit gap in the Positive Health Check arm for the youngest participants, 18-29 years old [aRR (95% CI) = 0.55 (0.33 to 0.92), P = 0.024] and the oldest participants, 60-81 years old [aRR (95% CI) = 0.49 (0.30 to 0.81), P = 0.006]. CONCLUSIONS Positive Health Check may help male participants with HIV achieve viral suppression, and younger and older patients consistently attend HIV care. REGISTRY NAME Positive Health Check Evaluation Trial. Trial ID: 1U18PS004967-01. URL: https://clinicaltrials.gov/ct2/show/NCT03292913.
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Affiliation(s)
| | - Camilla Harshbarger
- Division of HIV Prevention, Centers for Disease Control and Prevention, Atlanta, GA
| | | | - Vincent C. Marconi
- Division of Infectious Diseases, Emory University School of Medicine, Emory Vaccine Center, and Rollins School of Public Health, Atlanta, Georgia; VA Medical Center, Decatur, GA
| | | | | | | | | | - Carla Galindo
- Division of HIV Prevention, Centers for Disease Control and Prevention, Atlanta, GA
| | - Craig B. Borkowf
- Division of HIV Prevention, Centers for Disease Control and Prevention, Atlanta, GA
| | - Gary Marks
- Division of HIV Prevention, Centers for Disease Control and Prevention, Atlanta, GA
| | | | | | | | | | | | - Cari Courtenay-Quirk
- Division of HIV Prevention, Centers for Disease Control and Prevention, Atlanta, GA
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