January 16, 2001
Del Rio heads Atlanta
of four-city HIV study
By Alicia Lurry
A new study, launched Jan. 1 at Grady Hospital and other area health care providers and testing centers, will seek to determine whether case-management intervention will improve attendance and use of health care services by individuals newly diagnosed with HIV infection.
The Antiretroviral Treatment and Access Study (ARTAS) is funded with
a four-year, multisite grant by the Centers for Disease Control and Prevention
(CDC) and will look specifically at strategies to increase access to care
for low-income, HIV-infected persons. The study sites are Atlanta, Baltimore,
Los Angeles and Miami, and will focus on disadvantaged populations,
including minorities, the uninsured and drug users.
A substantial proportion of newly diagnosed HIV-infected persons do not
immediately seek an HIV care provider or clinic and may stay hidden
in more advanced stages of HIV infection. The ARTAS study hopes to determine
if case management can bridge the gap between HIV diagnosis
and entry into care.
The primary objective of the study is to measure the impact of interventions.
Secondary objectives include determining client-identified barriers to
accessing HIV care and demographic and behavioral information.
Each site will enroll 150 persons newly diagnosed with HIV. Potential
participants will be screened at sexually transmitted disease clinics,
community clinics, university-based research clinics, drug treatment centers,
hospital inpatient services, and counseling and testing sites. HIV counseling
will be provided to all participants as part of the baseline enrollment
Carlos Del Rio, associate professor of medicine and director of HIV Inpatient
Services at Grady Hospital, said the CDC has big hopes for the study.
The CDC hopes the study can lead to recommendations on policies
about how to get patients into care nationwide, Del Rio said.
Participants must be 18 or older. Other criteria include an initial diagnosis
of HIV infection within the previous three months (HIV diagnosis will
be confirmed from medical records or testing facility records); residence
within the catchment area of local providers, including homeless persons;
and ability to give informed consent.
Persons volunteering in the study will be randomized into two groups.
One will receive the standard post-test counseling currently offered by
the various sites participating in the study, meaning they will be referred
to an HIV care provider and encouraged to seek and remain in care.
The second arm of the study is the case-management intervention arm.
These participants will receive the same care as those in the standard-of-care
group, in addition to a highly structured intervention based on a strengths-based
model. Components of the intervention include accompanying the client
to the initial HIV care visit and reinforcing issues raised in the initial
encounter with the care provider (i.e., benefits of ART, the rigors of
pill-taking, side effects of treatment; and desirability of additional
Attention will also be given to completing a needs assessment to identify
barriers and to actively linking the client to other services, such as
assisting with applications for housing, insurance or public assistance;
transportation to childcare; and transferring the client to the case manager
or social worker at the health care site, if needed.
All participants will complete a questionnaire at the time of enrollment and at six-month and 12-month followups.