Entry and retention in medical care among HIV-diagnosed persons: a meta-analysis

Marks, Gary; Gardner, Lytt I.; Craw, Jason; Crepaz, Nicole

doi:10.1097/qad.0b013e32833f4b1b

Cited by 218 publications

(177 citation statements)

References 63 publications

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“…It is also clear that measuring clinical retention accurately per policy guidelines and refining targets for improvement are consistent with the recent emphasis on a "test and treat strategy" to rapidly diagnose HIV-infected persons and engage them in continuous care, which has been theorized to "bend the incidence curve" of HIV in the United States and Canada downward (30,31). Therefore, in this study we sought to leverage longitudinal clinical data available within a large, demographically and geographically diverse collaborative consortium of cohort studies to elucidate the critical and underexplored issue of misclassification when using laboratory proxies for clinical encounters in describing the epidemiology of clinical retention.…”

Section: Discussionmentioning

confidence: 96%

Laboratory Measures as Proxies for Primary Care Encounters: Implications for Quantifying Clinical Retention Among HIV-Infected Adults in North America

Rebeiro¹,

Althoff²,

Lau³

et al. 2015

Am. J. Epidemiol.

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Because of limitations in the availability of data on primary care encounters, patient retention in human immunodeficiency virus (HIV) care is often estimated using laboratory measurement dates as proxies for clinical encounters, leading to possible outcome misclassification. This study included 83,041 HIV-infected adults from 14 clinical cohorts in the North American AIDS Cohort Collaboration on Research and Design (NA-ACCORD) who had ≥1 HIV primary care encounters during 2000-2010, contributing 468,816 person-years of follow-up. Encounter-based retention (R EB ) was defined as ≥2 encounters in a calendar year, ≥90 days apart. Laboratory-based retention (R LB ) was defined similarly, using the dates of CD4-positive cell counts or HIV-1 RNA measurements. Percentage of agreement and the κ statistic were used to characterize agreement between R LB and R EB . Logistic regression with generalized estimating equations and stabilized inverse-probability-of-selection weights was used to elucidate temporal trends and the discriminatory power of R LB as a predictor of R EB , accounting for age, sex, race/ethnicity, primary HIV risk factor, and cohort site as potential confounders. Both R EB and R LB increased from 2000 to 2010 (from 67% to 78% and from 65% to 77%, respectively), though R EB was higher than R LB throughout (P < 0.01). R LB agreed well with R EB (80%-86% agreement; κ = 0.55-0.62, P < 0.01) and had a strong, imperfect ability to discriminate between persons retained and not retained in care by R EB (C statistic: C = 0.81, P < 0.05). As a proxy for R EB , R LB had a sensitivity and specificity of 84% and 77%, respectively, with misclassification error of 18%. clinical encounters; clinical retention; HIV; laboratory measurements; measurement error; misclassification; proxies Abbreviations: AIDS, acquired immunodeficiency syndrome; CI, confidence interval; HIV, human immunodeficiency virus; HIV-1, HIV type 1; IDU, injection drug user; IPW, inverse-probability-of-selection weights; NA-ACCORD, North American AIDS Cohort Collaboration on Research and Design; ROC, receiver operating characteristic; ROR, ratio of odds ratios.Access to health care and its utilization for clinical monitoring in both healthy populations (for preventive care) and unhealthy populations (for treatment) are vital components of improving health outcomes. The reliable and ongoing use of clinical services by patients as part of disease management, or retention in care, is one such indicator of health-care utilization. Epidemiologic tools have long been recognized as being both available and useful for evaluation of evidence and formulation of policies for health services (1). With healthcare reform (e.g., the Affordable Care Act) removing barriers to linkage to care in the United States, an understanding of how people seek health care and are retained in care is likely to become increasingly valuable (2, 3). These questions speak to identifying disparities in our health-care system and may have a large impact on patient outcomes.The study of...

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Section: Discussionmentioning

confidence: 96%

Laboratory Measures as Proxies for Primary Care Encounters: Implications for Quantifying Clinical Retention Among HIV-Infected Adults in North America

Rebeiro¹,

Althoff²,

Lau³

et al. 2015

Am. J. Epidemiol.

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“…While the "test and treat" strategy is still being studied, it is thus far most successful for newly diagnosed patients with high entry and retention rates in HIV medical care. 14 The primary limitation of our program is that we were not able to offer testing to every patient in the ED. Our test acceptance rate indicates we should be successful in testing the remaining ED patients, if we are able to expand our testing efforts.…”

Section: Discussionmentioning

confidence: 99%

Efficacy of an Emergency Department-Based HIV Screening Program in the Deep South

et al. 2011

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Human Immunodeficiency Virus (HIV) and Acquired Immunodeficiency Syndrome (AIDS) continue to be a significant public health concern in the United States. It disproportionately affects persons in the Deep South of the United States, specifically African Americans. This is a descriptive report of an Emergency Department (ED)-based HIV screening program in the Deep South using the 2006 Centers for Disease Control and Prevention (CDC) recommendations for rapid testing and opt-out consent. Between May 2008 and March 2010, patients presenting for medical care to the ED Monday through Friday between 10 AM and 10 PM were approached for HIV screening. Patients were eligible for screening if they were 18 or older, had no previous history of positive HIV tests, were English-Speaking, and were not incarcerated, medically unstable, or otherwise able to decline testing. All patients were tested using the OraQuick® rapid HIV 1/2 antibody test. Patients with non-reactive results were referred to community anonymous testing sites for further testing. Patients with reactive results had confirmatory Western blot and CD4 counts drawn and were brought back to the ED for disclosure of the results. All patients with confirmed HIV positive via reactive Western blot were referred to the hospital-based infectious disease clinic or county health department. We tested 7,616 patients out of 8,922 approached. The overall test acceptance rate was 85.4%. 91.0% of patients tested were African American. The most common reason for refusal was recent HIV test. 1.7% of patients tested were confirmed HIV positive via Western blot. 95.2% of patients testing HIV positive were African American. The average CD4 count for patients testing positive was 276 cells/μl, with 42.0% of patients having CD4 counts ≤200 μl, consistent with an AIDS diagnosis. 88.4% of patients who had reactive oral swabs returned for Western blot results and 75.0% of patients attended their first clinic visit. We have been able to successfully carry out an ED-based HIV screening program in a resource-poor urban teaching facility in the Deep South. We define our success based on our relatively high test acceptance rate and high rate of attendance at first clinic visit. Our patient population has a relatively high undocumented HIV prevalence and are at advanced stage of disease at the time of diagnosis.

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“…5 Adherence to antiretroviral therapy (ART) is a challenge for persons living with HIV (PLWH), with an estimated 40% dropping out of care within the first 2 years of starting treatment. 18 In a variety of therapeutic classes, inconsistent adherence is associated with poor clinical outcomes, treatment failure, and increased health care costs. [19][20][21][22][23] In general, patients utilizing specialty community pharmacies receive more personalized care and have better adherence rates compared with those in nonspecialty community pharmacies.…”

Section: Opinions Of a Small Sample Of Pharmacists About Pharmacymentioning

confidence: 99%

Opinions of a Small Sample of Pharmacists About Pharmacy Setting and Patient Adherence to Antiretroviral Therapy

Kibicho

Owczarzak²,

Pinkerton³

2012

JMCP

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Entry and retention in medical care among HIV-diagnosed persons: a meta-analysis

Abstract: Entry and retention in HIV medical care in the United States are moderately high. Improvement in both outcomes will increase the success of a test and treat strategy.

Cited by 218 publications

References 63 publications

Laboratory Measures as Proxies for Primary Care Encounters: Implications for Quantifying Clinical Retention Among HIV-Infected Adults in North America

Laboratory Measures as Proxies for Primary Care Encounters: Implications for Quantifying Clinical Retention Among HIV-Infected Adults in North America

Efficacy of an Emergency Department-Based HIV Screening Program in the Deep South

Opinions of a Small Sample of Pharmacists About Pharmacy Setting and Patient Adherence to Antiretroviral Therapy

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