Wednesday, March 12, 2008
Retention in HIV care is associated with improved health outcomes in patients adherent to antiretroviral therapy.
To determine predictors of retention in HIV care by documenting the presence of CD4 count or viral load values as surrogates for attendance to HIV medical care after diagnosis.
Study cohort included newly diagnosed HIV-infected individuals reported to the HIV/AIDS Reporting System (HARS) from 1/1/2004 to 12/31/2005 and alive through 6/30/2007. Reporting of HIV laboratory markers is mandatory by SC law. Assuming that an HIV-infected individual after diagnosis is seen at least once every three months for HIV care, retention was documented as the proportion of quarters since HIV diagnosis in which a CD4 count or viral load result was reported. “Poor retention” is <75% of eligible time and “no show” were no reported values. Logistic regression models were used to determine predictors for retention in care.
Of the 1596 newly diagnosed individuals, 1503 were alive by 06/30/2007. Of these, 203/1503 (13.5%) did not present for care and 1216/1503 (80.9%) had a CD4 or viral load reported in <75% of eligible quarters (poor retention). “No show” was significantly associated with male gender (adjusted odds ratio [aOR]=2.23; 95% confidence interval [95%CI]=1.48, 3.37), age 50 years and older (aOR=0.31; 95%CI=0.16, 0.60), no identified risk category (aOR=4.47; 95%CI=2.90, 6.90), and for source of report, county health department (aOR=2.37; 95%CI=1.45, 3.88). “Poor retention” was significantly associated with black race (aOR=1.48; 95%CI=1.08, 2.02), age 50 years and older (aOR=0.43; 95%CI=0.27, 0.69), no identified risk category (aOR=1.73; 95%CI=1.19, 2.51) and urban residence (OR=1.35; 95%CI=1.01, 1.79).
In SC, approximately 4 out of 5 patients have “poor retention” in HIV medical care.
Programs should be developed to understand the reasons for delayed entry and poor retention in care, in order to improve health outcomes and decrease transmission potential.