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January 16, 2001

Del Rio heads Atlanta arm
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 information.

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 medical services).

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.