Psychosocial Symptom Differences among New Patient Groups at an HIV Medical Clinic: Project CONNECT

Background: Engagement and consistent HIV care visit attendance have been shown to be predictors of clinical outcomes. Between 2004 and 2006, 31% of our clinic patients missed their first visit. As a response to this “no show” phenomenon, a novel intervention based upon a patient navigation model, Project CONNECT (Client-Oriented New Patient Navigation to Encourage Connection to Treatment), was launched to improve new patient linkage to care.

Methods: The University of Alabama at Birmingham HIV/AIDS Clinic (1917 Clinic) is the largest primary HIV care provider in Alabama. Between January and December 2007, all 1917 Clinic patients were required to attend an orientation visit with social services personnel prior to their first medical provider visit. Orientation visits included assessment of psychological barriers to care via semi-structured interview and standardized self-report questionnaires (PHQ9-depression, PHQ-anxiety, AUDIT-alcohol risk, ASSIST-substance abuse). Initial laboratory work and clinician assessment of those with acute complaints occurred for all individuals. Participants were categorized as newly diagnosed, transferring care (from prior provider), and re-engaging (re-entering care after treatment absence of >1 year). Univariate analysis was used to explore differences among socio-demographic variables and self-reported measures between engagement groups.

Results: Overall, 361 patients scheduled an initial appointment through Project Connect, and 297 (82%) attended the orientation visit. Of those, 279 completed the psychosocial questionnaires. Depressive symptoms were reported by 65% of the sample, anxiety symptoms (38%), and current or past tobacco use (68%). Forty percent of the sample admitted to crack/cocaine use, amphetamine use (19%), opioid use (11%), and intravenous drug use (IVDU, 2%), and 38% were at risk for excessive alcohol consumption.

Participants transferring care (n=139, 50%), newly diagnosed (n=103, 37%) or re-engaging (n=37, 13%) were identified. Compared to the other engagement groups, more re-engaging patients reported symptoms of depression (80%), risk of alcohol consumption (48%), tobacco use (81%), cocaine use (44%), amphetamine use (34%), opioid use (17%), and IVDU (3%). Differences in tobacco and cocaine use were statistically significant, but all differences were clinically meaningful.

Conclusions: The number of patients reporting psychological symptoms was greater among those re-engaging care than those transferring care and even those newly diagnosed. This could be explained by the fact that they have been out of care for greater than one year with a chronic illness. The Project CONNECT intervention enabled social services personnel to play a crucial role in the early detection and prompt linkage to appropriate mental health and clinical services of our patients and illustrates the expanding role of these professionals in contemporary HIV care. Research is needed to further define and differentiate new patient groups and associated symptomotology and longitudinal clinical outcomes.