Enhancing Patient Retention in HIV Care: A Quality Improvement Project of the Emory Infectious Diseases Clinic Ryan White HIV/AIDS Program Restricted; Files Only

Walther, Ajay (Spring 2023)

Permanent URL: https://etd.library.emory.edu/concern/etds/wd375x569?locale=en


Background: While HIV is no longer considered a death sentence due to the availability of highly effective treatments such as Antiretroviral Therapy (ART), patients today still face significant psychosocial barriers to care, particularly those who live in poverty or are of lower socioeconomic status. Retaining these patients in care is critical to achieving viral suppression and slowing the spread of the virus. The Ryan White HIV/AIDS Program at the Emory Infectious Disease clinic aims to provide patients with HIV care and social services if they meet certain criteria. To achieve this aim, traditional methods of patient retention such as phone-based interventions must be analyzed for their effectiveness, which is what this study aims to explore as a quasi-experimental quantitative study. 

Methods: The methods used in this study involved chart extractions to examine the differences in patient attendances for HIV care visits between July and October of 2022. Phone calls were made to patients to assess why they missed appointments and comments were qualitatively recorded. Additionally, reminder calls were made to patients for appointments the next day. A numerical code was used during three separate analyses to highlight the frequencies of reasons for missed appointments. 

Results: From July to October, the first analysis showed that a majority of patients contacted did not answer the phone (46.15%, 57%, 43.14% and 41.18% for each month). A second analysis  conducted only focused on patients who did answer the phone and found that many patients had already canceled or rescheduled their appointments before the call, as well as that patients were either sick or had medical issues that prevented them from showing up. The no-show and appointment attendance rates did fluctuate from month to month, though several clinic staff anecdotally noted that the no-show rate fell during the course of the intervention. 

Conclusion: The data collected over the course of four months at the Emory Infectious Disease Clinic in Midtown Atlanta gives a somewhat clearer picture of the kinds of barriers that patients face to being retained in care, but also more importantly shows how many patients are unreachable by phone.

Table of Contents

Chapter 1: Introduction 1

Overview of the Problem

Overview of the Project 2

Chapter 2: Literature Review 4

What is HIV & What is The Ryan White Program? 4


The Ryan White Program 5

Treatment Regimen and Continuum of Care for HIV 7

Antiretroviral Therapy 7

The Continuum of Care 8

Barriers & Facilitators to Retention in HIV Care 9

What are the Barriers? 9

What are the Facilitators? 10

The Power of Phone Calls & The Value of Human Interaction 11

Human vs. Non-Human 11

Aspects of Patient Retention - Two Types of Calls 13

Pre-Visit Reminder Phone Calls 13

Follow-Up Calls for Missed Visits 14

Gaps in Literature 15

What More Must Be Done? 15

Chapter 3: Methodology 17

Overview of Methods 17

Basic Structure 17

Setting 17

Population & Timeframe 18

Study Design 18

Intervention 19

Data Collection 20

Analysis Methods & Use of Numerical Codes 21

Analysis of Psychosocial Barriers to Care 21

Analysis Methods for Non-Answering Patients 23

Chapter 4: Results & Analysis 24

Effect of Pre-Visit Reminder Phone Calls 24

Results of Psychosocial Barriers to Care 24

Results for Non-Answering Patients 28

Effect of Intervention on Appointment Attendance Rates 30

Rate of No-Show’s 30

Rate of Arrived Appointments 30

Rate of Appointments Canceled Between 2 and 24 Hours Beforehand 31

Chapter 5: Discussion & Public Health Implications 32

Discussion 32

Summary of the Results 32

Results in Context of the Literature 34

Implications for the Emory Infectious Disease Clinic 35

Limitations of Study 37

Conclusion of Study 38

Implications for Public Health 38

Implications for Future Research 38

Implications for Future Practice 39

Implications for Future Policy 40

Chapter 6: Conclusion 41

References 43

Appendix A 52

Script for Calling Patients Who Missed Appointments 52

Appendix B 54

Script for Calling Patients to Remind of Appointments 54

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