Factors Associated With Returning to HIV Care After a Gap in Care in New York State

Abstract

Background Retention in HIV care has important implications. Few studies examining retention include comprehensive and heterogeneous populations, and few examine factors associated with returning to care after gaps in care. We identified reasons for gaps in care and factors associated with returning to care. Methods We extracted medical record and state-wide reporting data from 1865 patients with one HIV visit to a New York facility in 2008 and subsequent 6-month gap in care. Using mixed effect logistic regression, we examined sociodemographic, clinical, and facility characteristics associated with returning to care. Results Most patients were men (63.2%), black (51.4%), had Medicaid (53.9%). Many had CD4 counts >500 cells/mm3 (34.4%) and undetectable viral loads (45.0%). Most (55.9%) had unknown reasons for gaps in care; of those with known reasons, reasons varied considerably. After a gap, 54.6% returned to care. Patients who did (vs. did not) return to care were more likely to have stable housing, longer duration of HIV, high CD4 count, suppressed VL, antiretroviral medications, and had facilities attempt to contact them. Those who returned to care were less likely to be uninsured and have mental health problems or substance use histories. Conclusion Over half of our sample of patients in New York with one HIV visit and subsequent 6-month gap in care returned to care; no major reasons for gaps emerged. Nevertheless, our findings emphasize that stabilizing patients’ psychosocial factors and contacting patients after a gap in care are key strategies to retain HIV-positive patients in care in New York.

Considering Care-Seeking Behaviors Reveals Important Differences Among HIV-Positive Women Not Engaged in Care: Implications for Intervention

“…14,[16][17][18][19] However, despite this finding, we found that, compared with women in care, both seekers and nonseekers were no more likely to perceive lack of health insurance as a barrier to care. Although prior studies have found drug use to be associated with poor engagement in care, 14,16,19,[21][22][23][24][25] we found that, compared with women in care, only non-seekers were more likely to report high-risk drug use and sexual behaviors. As this subgroup was less likely to report transportation as a barrier to care and was no more likely to report other structural barriers to care as women in care, our findings suggest that this subgroup of women may not report barriers because they are not actively seeking HIV medical care.…”

“…Consequently, they are at high risk for poor health outcomes and for transmitting HIV to others. [4][5][6][7][8][9][10] Although prior studies have identified numerous factors associated with poor engagement in care (e.g., lack of transportation [11][12][13] and health insurance, [14][15][16][17][18][19] caregiving responsibilities, 13,20 depression, 13,16,21 and substance use 14,16,19,[21][22][23][24][25], these studies have been limited in two important respects. First, many have viewed those who are not engaged in care as a single, homogenous group, failing to recognize potentially nuanced differences among women that may help to inform the development of targeted interventions.…”

Sex, Race, and HIV Risk Disparities in Discontinuity of HIV Care After Antiretroviral Therapy Initiation in the United States and Canada

“…First, we did not have data on income, education, employment, insurance coverage, or other contextual and social factors that have been associated with both retention and HIV disease outcomes in other studies and that may differ by demographic factors or HIV transmission risk group. 39,40 Some studies with single-sex populations have noted that poverty and housing instability reduce retention and ART adherence. 41,42 We maintain that the absence of these data has been mitigated by the fact that all patients under study were successfully engaged in care (a prerequisite for the NA-ACCORD) and had access to ART.…”

Barriers and Facilitators of HIV Care Engagement: Results of a Qualitative Study in St. Petersburg, Russia

“…Others are individual-level characteristics including substance abuse (15,19,21,22); younger age (22–24); depression and mental distress (14,17,19); having less advanced HIV disease (22,25); and misconceptions about HIV treatment (26). By contrast, factors found to facilitate HIV care linkage, engagement, and retention include integrated social and health care services and perceived support from providers (15,19,27–29); case management and care navigation (19,28,30); housing assistance (31,32); social support (19,33); and perceiving a responsibility to take care of one’s family (18). …”