Impact of Age on Retention in Care and Viral Suppression

Abstract

Background Retention in care is important for all HIV-infected persons and is strongly associated with initiation of antiretroviral therapy and viral suppression. However, it is unclear how retention in care and age interact to effect viral suppression. We evaluated whether the association between retention and viral suppression differed by age at entry into care. Methods Cross-sectional analysis (2006-2010) involving 17,044 HIV-infected adults in 14 clinical cohorts across the U.S. and Canada. Patients contributed one year of data during their first full calendar year of clinical observation. Poisson regression examined associations between retention measures [U.S. National HIV/AIDS Strategy (NHAS), U.S. Department of Health and Human Services (DHHS), 6-month gap, and 3-month visit constancy] and viral suppression (HIV RNA ≤200 copies/mL) by age group: 18-29, 30-39, 40–49, 50–59, and ≥60 years old. Results Overall, 89% of patients were retained in care using the NHAS measure, 74% with the DHHS indicator, 85% did not have a 6-month gap, and 62% had visits in 3-4 quarters of the year; 54% achieved viral suppression. For each retention measure, the association with viral suppression was significant for only the younger age groups (18-29 and 30-39 years): 18-29 [adjusted prevalence ratio (APR)=1.33, 95% confidence interval (CI)=1.03-1.70]; 30-39 (APR=1.23, CI=1.01-1.49); 40-49 (APR=1.06, CI=0.90-1.22); 50-59 (APR=0.92, CI=0.75-1.13); ≥60 years (APR=0.99, CI=0.63-1.56) using the NHAS measure as a representative example. Conclusions These results have important implications for improving viral control among younger adults, emphasizing the crucial role retention in care plays in supporting viral suppression in this population.

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

“…Retention in care and HIV disparities research have been linked through numerous studies describing the relationship between clinical engagement, access to and initiation of therapy, continuity of care, and viral suppression and other markers of HIV disease progression in various populations and settings, both in resource-rich and resource-limited settings. 12,13,15,16,18,[29][30][31] In fact, the relationship between retention disparities and lack of viral suppression alone merits close attention as viral suppression is a priority outcome in the NHAS, implicating improved individual outcomes and reduced HIV transmission. 5,8,[29][30][31] Few studies, however, have followed a cohort as large as the NA-ACCORD population over such a long period of time after ART initiation, a long enough period to directly observe the median times of first discontinuity of retention in care.…”

“…27,28 This retention measure has also been noted to correlate strongly with several other metrics and to be independently associated with negative clinical outcomes such as lack of viral suppression. 1,5,[29][30][31] This retention definition was anchored to calendar time to create estimates comparable with other studies and cliniclevel reports applying the indicator in regular reporting intervals. Disruption of continuous retention (discontinuity) was defined as the first instance of failing to meet the IOM indicator definition in any calendar year after ART initiation and before study follow-up ended.…”

“…Survival curves were created using predictions from both the weighted and adjusted estimates, noting that the stratified adjusted curves used covariate values fixed at their means across strata of the exposure of interest. (30,32) Because these were time-fixed confounders, single weights across all timepoints for an individual were used. The weights were also stabilized and truncated at the 5 th and 95 th percentiles to improve balance (Appendix Fig.…”

The Impact of Youth-Friendly Structures of Care on Retention Among HIV-Infected Youth

“…8,[26][27][28][29] Prior studies have shown the strong correlation between retention and viral load suppression. [30][31][32] With the notable disparities in outcomes and poor viral load suppression rates among youth, the importance of retaining young people in care is critical. Determining the structures of care available in HIV clinic settings that support retention in care for this challenging population can facilitate a greater number of youth to initiate ART earlier and ultimately achieve viral load suppression.…”

Impact of HIV care facility characteristics on the cascade of care in HIV-infected patients in the Netherlands

“…To fully benefit from cART, it is essential that HIV-infected persons successfully engage in all steps along the continuum of care [1].…”