Literature review
A systematic literature review was conducted by Northwestern University to identify evidence-based and evidence-informed approaches and interventions that are designed to engage PLWH who are not receiving or who are at risk of not continuing to receive HIV healthcare. The literature review consisted of several phases of targeted review and exclusion to produce a set of manuscripts describing interventions with linkage, re-engagement, and retention in care outcomes. For this review, linkage was defined as the initiation of HIV-related care (e.g., medical, psychological, social service-related) for people newly diagnosed with HIV or those that were previously diagnosed and never began treatment; re-engagement as a continuation of treatment or services for those diagnosed with HIV that have fallen out of care; and retention as regular engagement in care after being linked to or re-engaged in care. Included manuscripts should describe studies focused on the effectiveness of a clearly defined intervention or approach and describe linkage, retention, and/or re-engagement outcomes, not including HIV testing interventions with a passive referral or an inadequately described linkage component.
A research librarian developed a comprehensive search strategy in collaboration with the review authors. Searches were conducted on December 7, 2018, in the following databases: PubMed MEDLINE, Embase (Elsevier), Cochrane Library and Cochrane Register of Controlled Trials (CENTRAL) (Wiley), PsycINFO (Ebsco), and Web of Science. The PubMed MEDLINE search was adapted for all additional databases using database-specific logic and wildcards. All databases were searched back to 2005, and an English language filter was applied. The search strategy included terms related to 1) people living with HIV/AIDS; 2) treatment uptake, adherence, and retention; and 3) intervention, implementation, and evaluation. As this review was interested in interventions in the United States, citations that discussed countries other than the United States without mention of the United States were excluded using the Boolean NOT feature. This search yielded a total of 21,302 results across all databases after de-duplication. Eligible studies for analysis were identified using a combination of automatic and manual screening processes, as described in Fig. 1.
Request for information (RFI) survey
NASTAD developed an RFI survey to identify interventions that have not been published in academic literature using the same definitions described in the literature review process. The RFI was broadcasted through NASTAD’s membership network in conjunction with tailored outreach to a list of over 150 CBOs and ASOs across the country who work closely with marginalized groups, including lesbian, gay, bisexual, transgender, queer, intersex, and asexual (LGBTQIA+) populations as well as racial and ethnic minorities. Data on interventions were also collected using the same RFI structure via conference presentations (posters and oral presentations) from the 2018 National Ryan White Conference on HIV/AIDS, the 2019 National HIV Prevention Conference, 2019 Conference on Retroviruses and Opportunistic Infections, and 2019 SYNChronicity Conference. NASTAD identified 122 interventions, of which 83 met the inclusion criteria for key informant interviews to collect more information on outcomes, as described in Fig. 2.
Evidence rubric, impact score, and evidence and dissemination expert panel
Interventions selected from the literature review and the RFI processes were scored using an evidence rubric developed by Northwestern University in collaboration with HRSA and the Centers for Disease Control and Prevention (CDC). The evidence-based criteria established by the Agency for Healthcare Research and Quality and the CDC was used as a foundation for defining EB, and EI approaches. The rubric used a set of criteria to measure the strength and impact of evidence for each intervention to identify approaches, strategies, or models that are proven effective or show promise for improving the care and treatment for PLWH. The criteria used to measure each intervention’s level of evidence included quality of study design (e.g., study design, sample size, time to follow-up), the quality of intervention implementation and analysis (e.g., statistical testing, controlling for confounders, limitations), the strength of the evidence (e.g., positive intervention effects, control arms), and additional limitations and strengths not captured by other rubric components. Items within these categories were scored to determine whether the criteria were met and, where relevant, if the criteria were met with greater qualifications (e.g., larger sample sizes, larger effect size, a greater number of outcomes considered, improvement in clinical outcomes).
In addition to the evidence rubric, an evidence and dissemination expert panel was coordinated to review the final list of interventions that met the evidence threshold. Members were asked to review the evidence score for each intervention along with a summary of its methodology and outcomes. Through a series of discussions, each expert panel member assigned the intervention an “Impact Score” using a series of categories aimed at gauging the real-world impact of the intervention (e.g., feasibility, relevance, acceptability, sustainability, etc.). Final prioritization of interventions for inclusion in the CIE compendium was determined by the weight of the evidence score and the impact score, along with supplementary feedback from expert panel members. Only one intervention identified through the RFI was included in the final list of interventions for the CIE compendium, while the remaining interventions were identified through the literature review led by Northwestern University.
CIE compendium
The final CIE compendium consisted of 15 interventions: 1 focused on linkage to care, 2 focused on re-engagement, 9 focused on retention, and 3 focused on a combination of linkage, re-engagement, and/or retention. The majority of interventions constituted innovative service delivery models. NASTAD worked with intervention developers to create detailed implementation guides for 10 of the 15 interventions to serve as replication tools for diverse healthcare settings. Fact sheets were developed for the remaining 5 interventions highlighting key considerations from respective academic manuscripts. Implementation guides, intervention summaries, and supplementary replication resources (tip sheets, cost calculator, videos, etc.) were housed on the CIEhealth.org microsite hosted by NASTAD.