Measurement of retention in care among adults infected with HIV in an urban clinic

Abstract

Adults infected with HIV live longer when they receive regular medical care, yet many adults are not retained in care. Providers measure retention in order to evaluate interventions to improve retention and quality of HIV care. However, multiple measures for retention exist. This study compares two methods of operationalizing retention and evaluates the contribution of individual characteristics on the likelihood of retention. A chart review was performed for a random sample of 212 active clients of an urban HIV primary care clinic. Data on clinic utilization, sex, age, race, mental illness, substance use, AIDS diagnosis, language, and housing were collected for each participant. Clinic utilization data were used to classify participants for retention status and to score them by frequency of visits. Binary logistic regression analysis was compared with ordinal logistic regression analysis, using distinct retention measures as outcome variables. In the binary model, those with a history of substance use were about half as likely to be retained (OR 0.52, 95% CI 0.29-0.94) and those with an AIDS diagnosis were more than twice as likely to be retained (OR 2.18, 95% CI 1.17-4.09). These characteristics were significant predictors in the ordinal model, with the additional finding that those reporting English as a primary language were less likely to have higher retention scores (OR 0.40, 95% CI 0.19-0.84). An ordinal score for retention can identify unexpected predictors, but a dichotomous measure of retention may be easier to use and interpret for providers involved in retention-related quality improvement activities.

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.…”

“…We forced age and race/ethnicity into the multivariate models as these have been consistently associated with engagement in HIV care in previous studies. 6,17,[22][23][24][25] All analyses were conducted using SAS statistical software (SAS 9.2, SAS Institute, Inc., Cary, NC).…”

“…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.…”

Pain, Mood, and Substance Abuse in HIV

“…24, 26, 9, 13, 29, 30–35 Notably, patients with mood disorders and substance abuse have twice the odds of poor adherence to ART than patients without these conditions, 29, 36–38 and patients with active substance abuse are half as likely to be adherent to HIV clinic visits. 39 …”

The Influence of Neurocognitive Impairment, Alcohol and other Drug (AOD) Use, and Psychosocial Factors on Antiretroviral Treatment Adherence, Service Utilization and Viral Load Among HIV-Seropositive Adults

“…Alcohol abuse has been reported by up to 53% of adults with HIV (Galvan et al, 2002; and NCI ranging from asymptomatic neurocognitive impairment (ANI) to HIV-associated dementia (HAD) has been observed in about 37% of adult PLWH . Heavy alcohol use and NCI may have a negative synergistic effect on self-reported medication adherence and service utilization rates Marx, Malka, Ravishankar, & Schwartz, 2011;. Improving utilization of both HIV and substance abuse services is central to increasing treatment adherence and optimizing health outcomes for PLWH White House Office of National AIDS Policy, 2010).…”