Retention in Care of Adults and Adolescents Living With HIV in 13 US Areas

Hall, H. Irene; Gray, Kristen Mahle; Tang, Tian; Li, Jianmin; Shouse, Luke; Mermin, Jonathan

doi:10.1097/qai.0b013e318249fe90

Cited by 150 publications

(142 citation statements)

References 26 publications

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“…Observational studies suggest that approximately 62% of adolescents and young adults link to care within the first year of diagnosis. 35,39,40 Other studies indicate that adolescents and young adults are less likely to link and remain in care than older adults. [40][41][42] Some studies using different age ranges for analysis found no difference in linkage in younger adults.…”

Section: Linkage To Carementioning

confidence: 99%

The Adolescent and Young Adult HIV Cascade of Care in the United States: Exaggerated Health Disparities

Zanoni

Mayer²

2014

AIDS Patient Care and STDs

362

315

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Little is known about how adolescents and young adults contribute to the declines in the cascade of care from HIV-1 diagnosis to viral suppression. We reviewed published literature from the Unites States reporting primary data for youth (13-29 years of age) at each stage of the HIV cascade of care. Approximately 41% of HIVinfected youth in the United States are aware of their diagnosis, while only 62% of those diagnosed engage medical care within 12 months of diagnosis. Of the youth who initiate antiretroviral therapy, only 54% achieve viral suppression and a further 57% are not retained in care. We estimate less than 6% of HIV-infected youth in the United States remain virally suppressed. We explore the cascade of care from HIV diagnosis through viral suppression for HIV-infected adolescents and young adults in the United States to highlight areas for improvement in the poor engagement of the infected youth population.

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Section: Linkage To Carementioning

confidence: 99%

The Adolescent and Young Adult HIV Cascade of Care in the United States: Exaggerated Health Disparities

Zanoni

Mayer²

2014

AIDS Patient Care and STDs

362

315

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“…This is denoted in the language of the Institute of Medicine report, which refers to laboratory measures as "proxies" for encounter-based measures (9,17). The use of CD4+ cell counts and HIV-1 RNA measurements to denote retention may also be of concern, since monitoring frequency guidelines or state/local reporting practices for HIV-related laboratory measures may change in different populations (19,33). In particular, as guidelines continue to decrease the recommended frequency of laboratory monitoring among stable patients on antiretroviral therapy, the degree to which laboratorybased measures will underestimate the population of retained patients will increase.…”

Section: Ratio Of Odds Ratiosmentioning

confidence: 99%

“…Laboratory data have been widely used as surrogate measures when data on primary care encounters are unavailable, as is often the case in large surveillance studies using public health laboratory data or cross-sectional population-based surveys that sample across defined geographic areas (e.g., county or state surveys). Such measures have been shown to be good indicators of initial or overall access to clinical HIV care (17), but there are no longitudinal data regarding concordance between measures of retention defined by HIV primary care encounters and those using surrogate laboratory measures (6,9,18,19).…”

mentioning

confidence: 99%

Laboratory Measures as Proxies for Primary Care Encounters: Implications for Quantifying Clinical Retention Among HIV-Infected Adults in North America

Rebeiro¹,

Althoff²,

Lau³

et al. 2015

Am. J. Epidemiol.

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Because of limitations in the availability of data on primary care encounters, patient retention in human immunodeficiency virus (HIV) care is often estimated using laboratory measurement dates as proxies for clinical encounters, leading to possible outcome misclassification. This study included 83,041 HIV-infected adults from 14 clinical cohorts in the North American AIDS Cohort Collaboration on Research and Design (NA-ACCORD) who had ≥1 HIV primary care encounters during 2000-2010, contributing 468,816 person-years of follow-up. Encounter-based retention (R EB ) was defined as ≥2 encounters in a calendar year, ≥90 days apart. Laboratory-based retention (R LB ) was defined similarly, using the dates of CD4-positive cell counts or HIV-1 RNA measurements. Percentage of agreement and the κ statistic were used to characterize agreement between R LB and R EB . Logistic regression with generalized estimating equations and stabilized inverse-probability-of-selection weights was used to elucidate temporal trends and the discriminatory power of R LB as a predictor of R EB , accounting for age, sex, race/ethnicity, primary HIV risk factor, and cohort site as potential confounders. Both R EB and R LB increased from 2000 to 2010 (from 67% to 78% and from 65% to 77%, respectively), though R EB was higher than R LB throughout (P < 0.01). R LB agreed well with R EB (80%-86% agreement; κ = 0.55-0.62, P < 0.01) and had a strong, imperfect ability to discriminate between persons retained and not retained in care by R EB (C statistic: C = 0.81, P < 0.05). As a proxy for R EB , R LB had a sensitivity and specificity of 84% and 77%, respectively, with misclassification error of 18%. clinical encounters; clinical retention; HIV; laboratory measurements; measurement error; misclassification; proxies Abbreviations: AIDS, acquired immunodeficiency syndrome; CI, confidence interval; HIV, human immunodeficiency virus; HIV-1, HIV type 1; IDU, injection drug user; IPW, inverse-probability-of-selection weights; NA-ACCORD, North American AIDS Cohort Collaboration on Research and Design; ROC, receiver operating characteristic; ROR, ratio of odds ratios.Access to health care and its utilization for clinical monitoring in both healthy populations (for preventive care) and unhealthy populations (for treatment) are vital components of improving health outcomes. The reliable and ongoing use of clinical services by patients as part of disease management, or retention in care, is one such indicator of health-care utilization. Epidemiologic tools have long been recognized as being both available and useful for evaluation of evidence and formulation of policies for health services (1). With healthcare reform (e.g., the Affordable Care Act) removing barriers to linkage to care in the United States, an understanding of how people seek health care and are retained in care is likely to become increasingly valuable (2, 3). These questions speak to identifying disparities in our health-care system and may have a large impact on patient outcomes.The study of...

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“…This challenge appears to be greatest in the USA where, in 2008, only 63% of HIV-infected men who have sex with men (MSM) were established in care following HIV diagnosis and 48% retained in care year on year [6]. Consequently, it was estimated that only 19% of the 1.1 million adults living with HIV in the USA had an undetectable viral load, reducing their risk of transmission.…”

Section: Introductionmentioning

confidence: 99%

“…However, even if early treatment for the diagnosed HIVpositive population is found to be clinically beneficial, there is continued uncertainty about a population-level prevention effect [5] that could be achieved if ART coverage were high enough to reduce 'community viral load' (CVL) [1]. This challenge appears to be greatest in the USA where, in 2008, only 63% of HIV-infected men who have sex with men (MSM) were established in care following HIV diagnosis and 48% retained in care year on year [6]. Consequently, it was estimated that only 19% of the 1.1 million adults living with HIV in the USA had an undetectable viral load, reducing their risk of transmission.…”

mentioning

confidence: 99%

HIV treatment as prevention among men who have sex with men in the UK: is transmission controlled by universal access to HIV treatment and care?

2013

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ObjectivesIn the UK, free HIV care is provided through dedicated HIV clinics. Using the national cohort of men who have sex with men (MSM) with diagnosed HIV infection and estimates of the number of undiagnosed men, we assessed whether high retention in HIV care and treatment coverage is sufficient to reduce HIV transmission. MethodsAntiretroviral therapy (ART) uptake and viral load distribution among diagnosed men were analysed by treatment status and CD4 count for the period between 2006 and 2010. A multiparameter evidence synthesis (MPES) method was used to estimate the size of the undiagnosed population. The viral load distribution among newly diagnosed untreated men was applied to the undiagnosed population. Infectivity was defined as a viral load > 1500 HIV-1 RNA copies/mL. ResultsBetween 2006 and 2010, ART coverage among all HIV-infected MSM (diagnosed and undiagnosed) increased from 49 to 60%, while the proportion of infectious men fell from 47 to 35%. Over the same period, the number of all HIV-infected MSM increased from 30 000 to 40 100 and the number of infectious MSM remained stable at 14 000. Of the 14 000 infectious MSM in 2010, 62% were undiagnosed, 33% were diagnosed but untreated, and 5% received ART. Extending ART to all diagnosed HIV-infected MSM with CD4 counts < 500 cells/mL in 2010 would have reduced the overall proportion of infectious men from 35 to 29% and halving the proportion who were undiagnosed would further have reduced this to 21%. ConclusionsHigh ART coverage in the UK has reduced the infectivity of the HIV-diagnosed population. However, the effectiveness of treatment as prevention will be limited unless the undiagnosed population is reduced through frequent HIV testing and consistent condom use. IntroductionThe demonstration that prevention of HIV transmission was possible through antiretroviral therapy (ART) was described as 'a defining moment for HIV control' in mid-2011 [1] and the 'breakthrough of the year' for scientific research in December 2011 [2]. ART has been shown to be highly efficacious at preventing transmission from HIVinfected to HIV-negative heterosexual partners, providing that the HIV-positive partner adheres to treatment so that their viral load becomes undetectable [3].While the benefit of HIV treatment for HIV-negative heterosexuals in HIV-serodiscordant relationships has been demonstrated, there is uncertainty surrounding the clinical benefits of 'early' ART (starting ART before the CD4 count reaches 500 cells/mL) for HIV-positive individuals. ORIGINAL RESEARCH 563The START trial [4] is designed to identify the impact of early ART initiation among the HIV-diagnosed population on the development of AIDS-related and non-AIDS-related illnesses. Additional measurable outcomes include adherence, the development of antiretroviral resistance and patient satisfaction. This work will directly inform future national and international treatment policies. However, even if early treatment for the diagnosed HIVpositive population is found to be clinically beneficial,...

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Retention in Care of Adults and Adolescents Living With HIV in 13 US Areas

Abstract: Less than half of persons living with HIV had laboratory evidence of ongoing clinical care and only two thirds established care after diagnosis. Further assessments determining modifiable barriers to accessing care could assist with achieving public health targets.

Cited by 150 publications

References 26 publications

The Adolescent and Young Adult HIV Cascade of Care in the United States: Exaggerated Health Disparities

The Adolescent and Young Adult HIV Cascade of Care in the United States: Exaggerated Health Disparities

Laboratory Measures as Proxies for Primary Care Encounters: Implications for Quantifying Clinical Retention Among HIV-Infected Adults in North America

HIV treatment as prevention among men who have sex with men in the UK: is transmission controlled by universal access to HIV treatment and care?

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