Characterizing the “No Show” Phenomenon and the Predictors of Poor Retention in Care Among HIV-infected Individuals in South Carolina, January 1 2004 to June 30 2007

Background:
Retention in HIV care is associated with improved health outcomes in patients adherent to antiretroviral therapy.

Objective:
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.

Method:
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.

Result:
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).

Conclusion:
In SC, approximately 4 out of 5 patients have “poor retention” in HIV medical care.

Implications:
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.