“Out of Care” HIV Case Investigations: A Collaborative Analysis Across 6 States in the Northwest US

Abstract

Background HIV care continuum estimates derived from laboratory surveillance typically assume that persons without recently reported CD4 count or viral load results are out of care. Methods We conducted a multi-state project (Alaska, Idaho, Montana, Oregon, Washington and Wyoming) to ascertain the status of HIV cases that appeared to be out of care during a 12 month period. We used laboratory surveillance to identify cases in all states but Idaho, where viral load reporting is not mandatory, requiring us to rely on clinic records. After complete investigation, we assigned each case one of the following dispositions: moved out of state, died, in HIV care, no evidence of HIV care, or data error. Results We identified 3,866 cases with no CD4 count or viral load result in a ≥12 month period during 2012-14, most (85%) of which were in Washington or Oregon. A median of 43% (range: 20%-67%) of cases investigated in each state had moved, 9% (0%-16%) had died, and 11% (8%-33%) were in care during the 12 month surveillance period. Only 28% of investigated cases in the region and a median of 30% (10%-57%) of investigated cases in each state had no evidence of care, migration, or death after investigation. Conclusions Most persons living with HIV in the Northwest US who appear to be out of care based on laboratory surveillance are not truly out of care. Our findings highlight the importance of improving state surveillance systems to ensure accurate care continuum estimates and guide Data to Care efforts.

A Cluster Randomized Evaluation of a Health Department Data to Care Intervention Designed to Increase Engagement in HIV Care and Antiretroviral Use

“…Two DIS investigated cases according to a standardized protocol described in detail elsewhere. 26 DIS searched all available HIV/STD public health databases, electronic health records, death records, and a Lexis Nexis® database. If this did not yield a disposition, DIS contacted the medical provider.…”

Defining Care Patterns and Outcomes Among Persons Living with HIV in Washington, DC: Linkage of Clinical Cohort and Surveillance Data

“…A participant was defined as meeting the definition of being retained in care (RIC) if there was evidence of at least two HIV-related encounters (eg, either HIV-related medical visit and/or laboratory test results) at least 90 days apart in a 12-month period from June 15, 2014 to June 15, 2015 [ 6 , 16 , 28 - 31 ]. For the purposes of this analysis, a participant was considered RIC even if the encounters occurred at multiple sites.…”

Access to HIV care in jails: Perspectives from people living with HIV in North Carolina

“…Periods of incarceration can disrupt continuity of HIV care and impact the ability to maintain adherence to antiretroviral therapy (ART) and achieve viral suppression [2][3][4][5]. At the same time, incarceration can provide an opportunity to re-engage PLWH in care and optimize healthcare [6,7].…”