Evaluating patterns in retention, continuation, gaps, and re-engagement in HIV care in a Medicaid-insured population, 2006–2012, United States

Byrd, Kathy K.; Furtado, Melissa; Bush, Timothy J.; Gardner, Lytt I.

doi:10.1080/09540121.2015.1114991

Cited by 16 publications

(26 citation statements)

References 22 publications

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“…; 2) two-year retention: did the participant attend at least one visit in each of the four 6-month blocks during the two years? ; and 3) one-year retention: did the participant attend at least one visit in three or four of the four quarter-years during the one year before enrollment[ 17 – 19 ]? Finally, to summarize the retention data, we created a single variable representing poor retention in care in which participants meeting any of the three measures of poor retention were considered to have some evidence of poor retention in the past 2 years.…”

Section: Methodsmentioning

confidence: 99%

Veterans’ Perspectives on Interventions to Improve Retention in HIV Care

et al. 2016

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Poor retention in HIV medical care is associated with increased mortality among patients with HIV/AIDS. Developing new interventions to improve retention in HIV primary care is needed. The Department of Veteran Affairs (VA) is the largest single provider of HIV care in the US. We sought to understand what veterans would want in an intervention to improve retention in VA HIV care. We conducted 18 one-on-one interviews and 15 outpatient focus groups with 46 patients living with HIV infection from the Michael E. DeBakey VAMC (MEDVAMC). Analysis identified three focus areas for improving retention in care: developing an HIV friendly clinic environment, providing mental health and substance use treatment concurrent with HIV care and encouraging peer support from other Veterans with HIV.

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Section: Methodsmentioning

confidence: 99%

Veterans’ Perspectives on Interventions to Improve Retention in HIV Care

et al. 2016

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“…Other estimates of retention in HIV care, from clinical or administrative claims data, which typically examine 1 or 2 years of follow-up data, range from 59% to 82%, although most of these studies have not accounted for the dynamic movement into and out of care (i.e., reengagement in care). 4,16–21 In a previous report of a Medicaid-insured population, from 2006 to 2012, retention in HIV care over the initial 24 months of observation was 61%, subsequent retention in HIV care at 84 months was 53%, and between 8% and 30% of persons experienced a gap in HIV care of more than 6 months. 21 The substantial proportion of persons who fall out of care or experience gaps in care have public health implications because ~60% of new HIV infections are transmitted from persons who are HIV diagnosed, but not fully retained in medical care.…”

Section: Introductionmentioning

confidence: 99%

“…4,16–21 In a previous report of a Medicaid-insured population, from 2006 to 2012, retention in HIV care over the initial 24 months of observation was 61%, subsequent retention in HIV care at 84 months was 53%, and between 8% and 30% of persons experienced a gap in HIV care of more than 6 months. 21 The substantial proportion of persons who fall out of care or experience gaps in care have public health implications because ~60% of new HIV infections are transmitted from persons who are HIV diagnosed, but not fully retained in medical care. 22 In this report, we provide estimates of persons who experience gaps in care and then reengage in care over a period of 60 months, as well as factors associated with time to a gap in care and time to reengagement.…”

Section: Introductionmentioning

confidence: 99%

Reengagement in Care After a Gap in HIV Care Among a Population of Privately Insured Persons with HIV in the United States

Byrd

Furtado²,

Bush

et al. 2016

AIDS Patient Care and STDs

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The HIV care continuum illustrates steps needed to reach HIV viral suppression, including retention in care. The continuum’s retention measure does not account for gaps or reengagement in care and thus provides an incomplete picture of long-term engagement. We used a claims database to determine the proportion of privately insured persons with HIV who experienced a gap in care and subsequently reengaged between 2008 and 2012. A gap was defined as no office visit claim in >6 months and reengagement as ≥1 office visit claim after a gap. Cox proportional hazards models were conducted to determine factors associated with time to first gap and time to reengagement. Of 5142 persons in the study, 79% were males and median age was 46 years (range, 19–64 years). No race/ethnicity data were available. Thirty percent (n=1555) experienced a gap. Median time to first gap was 15 months (IQR: 6–30). Median gap length was 3.2 months. Seventy percent with a gap reengaged; 22% reengaged more than once. Of 1086 patients who reengaged, 224 (21%) eventually had a terminal gap. Residence in the North Central region (HR 0.73, 95% CI 0.62–0.87) and having ≥1 Charlson comorbidities (HR 0.85, 95% CI 0.73–0.99) were associated with shorter time to reengagement. The majority who experienced a gap reengaged within a relatively short period and remained in the cohort at 60 months. However, 21% of those reengaging had a terminal gap by 60 months, which should alert providers to the eventual potential for loss to follow-up. The analysis was limited by inability to distinguish between HIVspecific and non-HIV-specific care visits.

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“…In 2 recent studies in the United States of publicly and commercially insured persons with HIV, up to 30% experienced gaps in care. 5,6 Although persons who have gaps in care are considered to be out of care, it is conceivable that some of these individuals continue to fill ARV drug prescriptions, during the gap, and could reach viral suppression.…”

Section: Introductionmentioning

confidence: 99%

Do Persons Living with HIV Continue to Fill Prescriptions for Antiretroviral Drugs during a Gap in Care? Analysis of a Large Commercial Claims Database

Byrd

Bush

Gardner

2017

J Int Assoc Provid AIDS Care

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The significance of a gap in HIV care depends, at least partially, on whether patients continue to fill prescriptions for antiretroviral (ARV) drugs during the gap in care. We used a billing claims database to determine the proportion of persons who filled 1 prescription for ARV drugs during a gap in care (no clinic visit in >6 months). Persons were stratified into 3 groups: “never” (prescriptions never filled), “sometimes” (prescriptions filled >0%-<100% of months), and “always” (prescriptions filled monthly). Logistic regression analyses were conducted to determine factors associated with “never” filling ARV drugs. Of 14 308 persons, 69% (n = 9817), 13% (n = 1928), and 18% (n = 2563) “never,” “sometimes,” and “always” filled ARV drugs during the gap in care. Persons aged 18 to 29 years (odds ratio [OR] = 1.56, 95% confidence interval [CI] 1.39–1.74), women (OR = 1.67, CI 1.52–1.83), and persons from the Northeast region of the United States (OR = 1.86, CI 1.69–2.03) were more likely to never fill ARV drugs than persons aged ≥30 years, men, and persons outside the Northeast, respectively. Efforts should be made to minimize gaps in care, emphasize importance of therapy, and provide adherence support.

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Evaluating patterns in retention, continuation, gaps, and re-engagement in HIV care in a Medicaid-insured population, 2006–2012, United States

Cited by 16 publications

References 22 publications

Veterans’ Perspectives on Interventions to Improve Retention in HIV Care

Veterans’ Perspectives on Interventions to Improve Retention in HIV Care

Reengagement in Care After a Gap in HIV Care Among a Population of Privately Insured Persons with HIV in the United States

Do Persons Living with HIV Continue to Fill Prescriptions for Antiretroviral Drugs during a Gap in Care? Analysis of a Large Commercial Claims Database

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