A systematic review of health service interventions to improve linkage with or retention in HIV care.

The importance of early linkage to and continuing retention in HIV care is increasingly recognised, particularly in light of the implications poor linkage and retention rates have for the effectiveness of HIV treatment as prevention strategies. The purpose of this systematic review was to examine the effectiveness of healthcare interventions in improving patient linkage to or retention in HIV care. We systematically searched PubMed (MEDLINE and PubMed-only citations) and EMBASE databases for articles reporting the original results of randomised controlled trials, and used a standard data collection form to extract information on study characteristics and outcome data. Five articles met the inclusion criteria, of which two articles focused on linkage to care and three on retention in care. The methodological quality, both of internal and external validity, of most of the trials was suboptimal. Wide variation in the interventions and outcome measures meant synthesis of the results using meta-analysis was not appropriate. This review shows evidence that interventions based on supporting patient self-management improves linkage to, and possibly retention in, care. Interventions aimed at delivery service design may also be effective, although evidence in this review was limited. It is vital that interventions are developed to improve patient engagement in HIV care. The dearth of research identified by this review highlights the need for well-designed trials of interventions in this area in the future.