Retaining people living with HIV (PWH) in high-quality specialist care by means of a hub-and-spoke outreach clinic

N. Connolly, J. Mellor, Hez Fothergill, G. Schembri, C. Babu, O. McQuillan

Research output: Contribution to journalMeeting Abstractpeer-review


Background: Access to and retention in high quality specialist HIV care is of major priority. PWH disengage for varied reasons. It is associated with worse outcomes for individual care & management of uncontrolled infection. Supervised treatment can also help prevent onward transmission. Genitourinary care at a DGH clinic had been provided by university hospital consultants since 2006 facilitated by the local sexual health network. Despite a cohort of 1600 PWH clinicians had been unable to provide HIV care at the smaller clinic due to funding restrictions so that 237 local PWH had to attend centres further afield with concerns being expressed regarding the lack of local provision

Methods: To improve care & retention an outreach clinic was established at the DGH GU clinic using medical & nursing expertise from both units. It opened in November 2011 six months prior to the successful acquisition of the DGH by the university hospital trust & was funded in anticipation of this. Patients were identified by postcode, new diagnoses at either unit from the local area, regional BASHH & HIV physician group, and self-referral via word of-mouth, community services & local media

Results: Since inception patient numbers have steadily increased to 39. A third were diagnosed at the DGH, ⅓ transferred from the larger centre with the final ⅓ transferring from other local or national clinics. Nine (24%) had disengaged from care. Two thirds (66%) require antiretrovirals and all are on ART except 1 who completed an advanced directive. The majority (88%) are undetectable or are within the first 6 months of treatment. The 2 still detectable had previously disengaged & have ongoing complex needs. 100% of respondents in a recent patient satisfaction survey rated the service as good, plan to continue attending & would recommend the clinic to a friend. 79% had no concerns about the clinic & for those who did it was for reasons of confidentiality & number of clinics which are being addressed. All those on treatment receive their medication via home delivery & to date there have been no complaints with this service

Conclusion: This hub & spoke model helps keep PWH both engaged in care and bring back those lost to follow-up. Outreach provides this without impact on quality if care remains under the auspices of a tertiary centre with a MDT approach & associated facilities. Engagement with service improves overall HIV control for individuals & can potentially reduce onward transmission.

Original languageEnglish
Pages (from-to)20
Number of pages1
JournalHIV Medicine
Issue numberS2
Publication statusPublished - 1 Apr 2013
Externally publishedYes
Event19th Annual Conference of the British HIV Association - Manchester, United Kingdom
Duration: 16 Apr 201319 Apr 2013
Conference number: 19


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