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Linthwaite B, Kronfli N, Lessard D, Engler K, Ruppenthal L, Bourbonnière E, Obas N, Brown M, Lebouché B, Cox J. Implementation of Lost & Found, An Intervention to Reengage Patients Out of HIV Care: A Convergent Explanatory Sequential Mixed-Methods Analysis. AIDS Behav 2022; 27:1531-1547. [PMID: 36271984 PMCID: PMC10130100 DOI: 10.1007/s10461-022-03888-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/03/2022] [Indexed: 11/29/2022]
Abstract
Being out of HIV care (OOC) is associated with increased morbidity and mortality. We assessed implementation of Lost & Found, a clinic-based intervention to reengage OOC patients. OOC patients were identified using a nurse-validated, real-time OOC list within the electronic medical records (EMR) system. Nurses called OOC patients. Implementation occurred at the McGill University Health Centre from April 2018 to 2019. Results from questionnaires to nurses showed elevated scores for implementation outcomes throughout, but with lower, more variable scores during pre-implementation to month 3 [e.g., adoption subscales (scale: 1-5): range from pre-implementation to month 3, 3.7-4.9; thereafter, 4.2-4.9]. Qualitative results from focus groups with nurses were consistent with observed quantitative trends. Barriers concerning the EMR and nursing staff shortages explained reductions in fidelity. Strategies for overcoming barriers to implementation were crucial in early months of implementation. Intervention compatibility, information systems support, as well as nurses' team processes, knowledge, and skills facilitated implementation.
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Affiliation(s)
- Blake Linthwaite
- Research Institute of the McGill University Health Centre (RI-MUHC), 2155 Guy Street, 5th Floor, Montreal, QC, H3H 2R9, Canada
| | - Nadine Kronfli
- Research Institute of the McGill University Health Centre (RI-MUHC), 2155 Guy Street, 5th Floor, Montreal, QC, H3H 2R9, Canada
- Department of Medicine, Division of Infectious Diseases and Chronic Viral Illness Service, McGill University, Montreal, QC, Canada
| | - David Lessard
- Research Institute of the McGill University Health Centre (RI-MUHC), 2155 Guy Street, 5th Floor, Montreal, QC, H3H 2R9, Canada
| | - Kim Engler
- Research Institute of the McGill University Health Centre (RI-MUHC), 2155 Guy Street, 5th Floor, Montreal, QC, H3H 2R9, Canada
| | - Luciana Ruppenthal
- Department of Medicine, Division of Infectious Diseases and Chronic Viral Illness Service, McGill University, Montreal, QC, Canada
| | - Emilie Bourbonnière
- Department of Medicine, Division of Infectious Diseases and Chronic Viral Illness Service, McGill University, Montreal, QC, Canada
| | - Nancy Obas
- Department of Medicine, Division of Infectious Diseases and Chronic Viral Illness Service, McGill University, Montreal, QC, Canada
| | - Melodie Brown
- Department of Medicine, Division of Infectious Diseases and Chronic Viral Illness Service, McGill University, Montreal, QC, Canada
| | - Bertrand Lebouché
- Research Institute of the McGill University Health Centre (RI-MUHC), 2155 Guy Street, 5th Floor, Montreal, QC, H3H 2R9, Canada
- Department of Medicine, Division of Infectious Diseases and Chronic Viral Illness Service, McGill University, Montreal, QC, Canada
- Department of Family Medicine, Faculty of Medicine, McGill University, 5858 Chemin de la Côte des Neiges, Montreal, QC, H3S 1Z1, Canada
| | - Joseph Cox
- Research Institute of the McGill University Health Centre (RI-MUHC), 2155 Guy Street, 5th Floor, Montreal, QC, H3H 2R9, Canada.
- Department of Medicine, Division of Infectious Diseases and Chronic Viral Illness Service, McGill University, Montreal, QC, Canada.
- Department of Epidemiology, Biostatistics, and Occupational Health, Faculty of Medicine, McGill University, Purvis Hall, 1020 Pine Avenue West, Montreal, QC, H3A 1A2, Canada.
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Fehr D, Lebouché B, Ruppenthal L, Brownc M, Obasc N, Bourbonnière E, Girouard J, Massicotte A, Jenabian MA, Almomen AA, Frenette C, de Pokomandy A, Cox J, Giannakis A, Cheng M, Kronfli N, Tsoukas C, Zahedi N, Szabo J, Dehghani K, Brouillette MJ, Falutz J, Turner H, Hamel A, Duchesneau C, Lanthier-Brun J, Klein M, Routy JP, Costiniuk CT. Characterization of people living with HIV in a Montreal-based tertiary care center with COVID-19 during the first wave of the pandemic. AIDS Care 2021; 34:663-669. [PMID: 33779425 DOI: 10.1080/09540121.2021.1904500] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
People living with HIV (PLWH) often have worse health outcomes compared to HIV-uninfected individuals. We characterized PLWH followed at a tertiary care clinic in Montreal who acquired COVID-19 and described their outcomes during the first wave of the pandemic. A retrospective chart review was performed for PLWH followed at the Chronic Viral Illness Service with a positive COVID-19 nasopharyngeal PCR or symptoms suggestive of COVID-19 between 1 March and 15 June 2020. Data on demographics, socioeconomic status, co-morbidities and severity of COVID-19 and outcomes were extracted. Of 1702 individuals, 32 (1.9%) had a positive COVID-19 test (n = 24) or symptoms suspicious for COVID-19 (n = 3). Median age was 52 years [IQR 40, 62]. Nearly all (97%) earned $34,999 Canadian dollars or less. Eleven (34%) individuals worked in long-term care (LTC) homes while 5 (6%) lived in LTC homes. Median CD4 count was 566 cells/mm3 [347, 726] and six had detectable plasma HIV viral loads. Median duration of HIV was 17 years [7, 22] and 30 individuals had been prescribed antiretroviral therapy. Five persons were asymptomatic. Of symptomatic persons, 21 (12%), 1 (4%) and 3 (12%) individuals had mild, moderate and severe disease, respectively. Three individuals died with COVID-19. In one case, the cause of death was due to COVID-19, whereas in the other two cases, the individuals died with positive COVID-19 test results but the immediate cause of death is unclear. PLWH who tested positive for COVID-19 had low socioeconomic status and had employment or living conditions that put them at high risk. PLWH may be disproportionately impacted by the social determinants of health which predispose them to COVID-19.
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Affiliation(s)
- Derek Fehr
- Department of Psychiatry, McGill University Health Centre, Royal Victoria Hospital: Glen Site, Montreal, Canada
| | - Bertrand Lebouché
- Department of Family Medicine, McGill University Health Centre, Royal Victoria Hospital: Glen Site, Montreal, Canada.,Division of Infectious Diseases/Chronic Viral Illness Service, McGill University Health Centre, Royal Victoria Hospital: Glen Site, Montreal, Canada.,Infectious Diseases and Immunity in Global Health, Research Institute of McGill University Health Centre, Montreal, Canada
| | - Luciana Ruppenthal
- Division of Infectious Diseases/Chronic Viral Illness Service, McGill University Health Centre, Royal Victoria Hospital: Glen Site, Montreal, Canada.,Department of Nursing, McGill University Health Centre, Montreal, Canada.,Royal Victoria Hospital: Glen Site, Montreal, Canada
| | - Melodie Brownc
- Department of Nursing, McGill University Health Centre, Montreal, Canada.,Royal Victoria Hospital: Glen Site, Montreal, Canada
| | - Nancy Obasc
- Department of Nursing, McGill University Health Centre, Montreal, Canada.,Royal Victoria Hospital: Glen Site, Montreal, Canada
| | - Emilie Bourbonnière
- Division of Infectious Diseases/Chronic Viral Illness Service, McGill University Health Centre, Royal Victoria Hospital: Glen Site, Montreal, Canada.,Department of Nursing, McGill University Health Centre, Montreal, Canada.,Royal Victoria Hospital: Glen Site, Montreal, Canada
| | - Josee Girouard
- Division of Infectious Diseases/Chronic Viral Illness Service, McGill University Health Centre, Royal Victoria Hospital: Glen Site, Montreal, Canada.,Infectious Diseases and Immunity in Global Health, Research Institute of McGill University Health Centre, Montreal, Canada
| | - Angie Massicotte
- Division of Infectious Diseases/Chronic Viral Illness Service, McGill University Health Centre, Royal Victoria Hospital: Glen Site, Montreal, Canada.,Infectious Diseases and Immunity in Global Health, Research Institute of McGill University Health Centre, Montreal, Canada
| | - Mohammad-Ali Jenabian
- Department of Biological Sciences, Université du Québec à Montréal, Montreal, Canada.,Department of Microbiology & Immunology, McGill University, Montreal, Canada
| | - Abdul-Aziz Almomen
- Department of Medical Microbiology, McGill University Health Centre, Royal Victoria Hospital: Glen Site, Montreal, Canada
| | - Charles Frenette
- Division of Infectious Diseases/Chronic Viral Illness Service, McGill University Health Centre, Royal Victoria Hospital: Glen Site, Montreal, Canada.,Department of Medical Microbiology, McGill University Health Centre, Royal Victoria Hospital: Glen Site, Montreal, Canada
| | - Alexandra de Pokomandy
- Department of Family Medicine, McGill University Health Centre, Royal Victoria Hospital: Glen Site, Montreal, Canada.,Division of Infectious Diseases/Chronic Viral Illness Service, McGill University Health Centre, Royal Victoria Hospital: Glen Site, Montreal, Canada.,Infectious Diseases and Immunity in Global Health, Research Institute of McGill University Health Centre, Montreal, Canada
| | - Joseph Cox
- Department of Family Medicine, McGill University Health Centre, Royal Victoria Hospital: Glen Site, Montreal, Canada.,Division of Infectious Diseases/Chronic Viral Illness Service, McGill University Health Centre, Royal Victoria Hospital: Glen Site, Montreal, Canada.,Infectious Diseases and Immunity in Global Health, Research Institute of McGill University Health Centre, Montreal, Canada
| | - Andreas Giannakis
- Division of Infectious Diseases/Chronic Viral Illness Service, McGill University Health Centre, Royal Victoria Hospital: Glen Site, Montreal, Canada
| | - Matthew Cheng
- Division of Infectious Diseases/Chronic Viral Illness Service, McGill University Health Centre, Royal Victoria Hospital: Glen Site, Montreal, Canada.,Infectious Diseases and Immunity in Global Health, Research Institute of McGill University Health Centre, Montreal, Canada
| | - Nadine Kronfli
- Division of Infectious Diseases/Chronic Viral Illness Service, McGill University Health Centre, Royal Victoria Hospital: Glen Site, Montreal, Canada.,Infectious Diseases and Immunity in Global Health, Research Institute of McGill University Health Centre, Montreal, Canada
| | - Christos Tsoukas
- Division of Infectious Diseases/Chronic Viral Illness Service, McGill University Health Centre, Royal Victoria Hospital: Glen Site, Montreal, Canada.,Infectious Diseases and Immunity in Global Health, Research Institute of McGill University Health Centre, Montreal, Canada.,Department of Microbiology & Immunology, McGill University, Montreal, Canada
| | - Navid Zahedi
- Division of Infectious Diseases/Chronic Viral Illness Service, McGill University Health Centre, Royal Victoria Hospital: Glen Site, Montreal, Canada
| | - Jason Szabo
- Department of Family Medicine, McGill University Health Centre, Royal Victoria Hospital: Glen Site, Montreal, Canada.,Division of Infectious Diseases/Chronic Viral Illness Service, McGill University Health Centre, Royal Victoria Hospital: Glen Site, Montreal, Canada
| | - Kianoush Dehghani
- Department of Family Medicine, McGill University Health Centre, Royal Victoria Hospital: Glen Site, Montreal, Canada.,Infectious Diseases and Immunity in Global Health, Research Institute of McGill University Health Centre, Montreal, Canada
| | - Marie-Josee Brouillette
- Department of Psychiatry, McGill University Health Centre, Royal Victoria Hospital: Glen Site, Montreal, Canada
| | - Julian Falutz
- Division of Infectious Diseases/Chronic Viral Illness Service, McGill University Health Centre, Royal Victoria Hospital: Glen Site, Montreal, Canada
| | - Howard Turner
- Division of Infectious Diseases/Chronic Viral Illness Service, McGill University Health Centre, Royal Victoria Hospital: Glen Site, Montreal, Canada
| | - Alexandra Hamel
- Division of Infectious Diseases/Chronic Viral Illness Service, McGill University Health Centre, Royal Victoria Hospital: Glen Site, Montreal, Canada
| | - Claire Duchesneau
- Department of Social Work, McGill University Health Centre, Montreal, Canada
| | | | - Marina Klein
- Division of Infectious Diseases/Chronic Viral Illness Service, McGill University Health Centre, Royal Victoria Hospital: Glen Site, Montreal, Canada.,Infectious Diseases and Immunity in Global Health, Research Institute of McGill University Health Centre, Montreal, Canada
| | - Jean-Pierre Routy
- Division of Infectious Diseases/Chronic Viral Illness Service, McGill University Health Centre, Royal Victoria Hospital: Glen Site, Montreal, Canada.,Infectious Diseases and Immunity in Global Health, Research Institute of McGill University Health Centre, Montreal, Canada.,Department of Microbiology & Immunology, McGill University, Montreal, Canada.,Division of Hematology, Department of Medicine, McGill University Health Centre, Royal Victoria Hospital: Glen Site, Montreal, Canada
| | - Cecilia T Costiniuk
- Department of Family Medicine, McGill University Health Centre, Royal Victoria Hospital: Glen Site, Montreal, Canada.,Infectious Diseases and Immunity in Global Health, Research Institute of McGill University Health Centre, Montreal, Canada.,Department of Microbiology & Immunology, McGill University, Montreal, Canada
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