Implementation ScienceEvaluation of a Public Health Referral System to Re-Engage Individuals Living With HIV Who Have Interrupted Antiretroviral Therapy in British Columbia, CanadaMoore, David M. MDCMa,b; Kremer, Hayden MAa; Wang, Lu MSca; Lepik, Katherine J. BSc, MHSca; Li, Jenny MSca; Salters, Kate PhDa,c; Montaner, Julio S. G. MDa,b; Tam, Clara MPHa; Kling, Rakel MD, MPHd; Bharmal, Aamir MDe; Goodison, Karin MD, MPHf; Pakhomova, Tatiana MPHa; Barrios, Rolando MDa,b Author Information aBritish Columbia Centre for Excellence in HIV/AIDS, Vancouver, Canada; bFaculty of Medicine, University of British Columbia, Vancouver, Canada; cSimon Fraser University, Burnaby, British Columbia; dNorthern Health Authority, Prince George, British Columbia; eFraser Health Authority, Surrey, British Columbia; and fInterior Health Authority, Kelowna, British Columbia. Correspondence to: David M. Moore, MDCM, BC Centre for Excellence in HIV/AIDS, 608-1081 Burrard Street, Vancouver, BC V6T 1Y6, Canada (e-mail: [email protected]). Some components of this study were presented at the 2020 Conference on Retroviruses and Opportunistic Infections; March 8–11, 2020; Boston, MA (Abstract # 1103). Supported by the British Columbia Ministry of Health. The BC HIV Drug Treatment Program is funded by the BC Ministry of Health through the Pharmacare Program. J.S.G.M. has received institutional grants from Gilead Sciences, J&J, Merck, ViiV Healthcare. J.S.G.M. has also served as an advisor to the Government of Canada and the Government of British Columbia in the last year. D.M.M. is supported by a Scholar Award from the Michael Smith Foundation for Health Research. The remaining authors have no conflicts of interest to disclose. JAIDS Journal of Acquired Immune Deficiency Syndromes: May 1, 2022 - Volume 90 - Issue 1 - p 33-40 doi: 10.1097/QAI.0000000000002914 Buy Metrics Abstract Background: In 2016, the British Columbia HIV/AIDS Drug Treatment Program modified its prescriber alert system for antiretroviral therapy (ART) interruptions to include referrals to regional public health nursing teams for direct outreach support for those who remain off treatment for 4 months or longer. We evaluated clinically relevant outcomes of this Re-Engagement and Engagement in Treatment for Antiretroviral Interrupted and Naïve populations (RETAIN) initiative, in comparison to previous time-periods. Methods: We analyzed ART interruptions triggering alerts in pre-RETAIN (July 2013-April 2016) and post-RETAIN periods (May 2016–October 2017) with follow-up continuing until October 2018. We compared the proportions of those who restarted ART and achieved viral suppression in pre-RETAIN and post-RETAIN periods and the time to ART restart using generalized estimating equations. Cox proportional hazards modelling was used to examine associations with time-to-ART-restart. Results: A total of 1805 individuals experienced ART interruptions triggering 3219 alerts; 2050 in pre-RETAIN and 1169 in post-RETAIN periods. Participants were predominantly men (74%) and had a median duration of ART of 5 years. Among persons who remained interrupted >4 months after an ART interruption alert was sent, the median time from interruption to ART re-initiation declined from 8.7 months to 7.4 months (P < 0.001) from pre-to post-RETAIN periods. Interruptions in the post-RETAIN era were associated with an increased hazard of restarting ART (adjusted hazard ratio 1.51; 95% CI: 1.34 to 1.69). Conclusions: Public health referrals shortened the length of ART interruptions after alerts sent to prescribers had not resulted in re-engagement. Similar programs should be considered in other jurisdictions. Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved.