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Longitudinal trajectories of HIV care engagement since diagnosis among persons with HIV in the Florida Ryan White program

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Abstract

HIV care engagement is a dynamic process. We employed group-based trajectory modeling to examine longitudinal patterns in care engagement among people who were newly diagnosed with HIV and enrolled in the Ryan White program in Florida (n = 9,755) between 2010 and 2015. Five trajectories were identified (47.9% “in care” with 1–2 care visit(s) per 6 months, 18.0% “frequent care” with 3 or more care visits per 6 months, 11.0% “re-engage”, 11.0% “gradual drop out”, 12.6% “early dropout”) based on the number of care attendances (including outpatient/case management visits, viral load or CD4 test) for each six-month during the first five years since diagnosis. Relative to “in care”, people in the “frequent care” trajectory were more likely to be Hispanic/Latino and older at HIV diagnosis, whereas people in the three suboptimal care retention trajectories were more likely to be younger. Area deprivation index, rurality, and county health rankings were also strongly associated with care trajectories. Individual- and community-level factors associated to the three suboptimal care retention trajectories, if confirmed to be causative and actionable, could be prioritized to improve HIV care engagement.

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References

  1. Crawford T, Sanderson W, Thornton A. Impact of poor retention in HIV medical care on time to viral load suppression. Journal of the International Association of Providers of AIDS Care. 2014;13(3):242–249.

  2. Mohammed D, Koumoulos L, Martin E, Slim J. Annual and durable HIV retention in care and viral suppression among patients of Peter Ho Clinic, 2013–2017. PloS one. 2020;15(12):e0244376.

  3. Stricker SM, Fox KA, Baggaley R, Negussie E, de Pee S, Grede N, et al. Retention in care and adherence to ART are critical elements of HIV care interventions. AIDS Behav. 2014;18(Suppl 5):465-75.

    Google Scholar 

  4. Amstutz A, Brown JA, Ringera I, Muhairwe J, Lejone TI, Klimkait T, et al. Engagement in Care, Viral Suppression, Drug Resistance, and Reasons for Nonengagement After Home-Based Same-Day Antiretroviral Therapy Initiation in Lesotho: A Two-Year Follow-up of the CASCADE Trial. Clin Infect Dis. 2020;71(10):2608–14.

    Article  CAS  Google Scholar 

  5. Brantley AD, Burgess S, Bickham J, Wendell D, Gruber D. Using Financial Incentives to Improve Rates of Viral Suppression and Engagement in Care of Patients Receiving HIV Care at 3 Health Clinics in Louisiana: The Health Models Program, 2013–2016. Public Health Rep. 2018;133(2_suppl):75S–86S.

    Article  Google Scholar 

  6. Baguso GN, Turner CM, Santos GM, Raymond HF, Dawson-Rose C, Lin J, et al. Successes and final challenges along the HIV care continuum with transwomen in San Francisco. J Int AIDS Soc. 2019;22(4):e25270.

    Article  Google Scholar 

  7. Vogler IH, Alfieri DF, Gianjacomo HDB, Almeida ERD, Reiche EMV. Cascade of care for people living with HIV infection in Southern Brazil: results from a public health network. Cad Saude Publica. 2018;34(12):e00009718.

    Article  Google Scholar 

  8. Giordano TP, Hartman C, Gifford AL, Backus LI, Morgan RO. Predictors of retention in HIV care among a national cohort of US veterans. HIV Clin Trials. 2009;10(5):299–305.

    Article  Google Scholar 

  9. Wiewel EW, Braunstein SL, Xia Q, Shepard CW, Torian LV. Monitoring outcomes for newly diagnosed and prevalent HIV cases using a care continuum created with New York city surveillance data. J Acquir Immune Defic Syndr. 2015;68(2):217–26.

    Article  Google Scholar 

  10. Powers KA, Samoff E, Weaver MA, Sampson LA, Miller WC, Leone PA, et al. Longitudinal HIV Care Trajectories in North Carolina. J Acquir Immune Defic Syndr. 2017;74(Suppl 2):88–95.

    Article  Google Scholar 

  11. Enns E, Reilly C, Horvath K, Baker-James K, Henry K. HIV Care Trajectories as a Novel Longitudinal Assessment of Retention in Care. AIDS and behavior. 2019;23(9):2532–2541.

  12. Mody A, Eshun-Wilson I, Sikombe K, Schwartz SR, Beres LK, Simbeza S, et al. Longitudinal engagement trajectories and risk of death among new ART starters in Zambia: A group-based multi-trajectory analysis. PLoS Med. 2019;16(10):e1002959.

    Article  Google Scholar 

  13. Hall HI, Tang T, Westfall AO, Mugavero MJ. HIV care visits and time to viral suppression, 19 U.S. jurisdictions, and implications for treatment, prevention and the national HIV/AIDS strategy. PLoS ONE. 2013;8(12):e84318.

    Article  Google Scholar 

  14. Edun B, Iyer M, Albrecht H, Weissman S. The South Carolina rural-urban HIV continuum of care. AIDS Care. 2017;29(7):817–22.

    Article  Google Scholar 

  15. Benbow ND, Aaby DA, Rosenberg ES, Brown CH. County-level factors affecting Latino HIV disparities in the United States. PLoS ONE. 2020;15(8):e0237269.

    Article  CAS  Google Scholar 

  16. Chandran A, Edmonds A, Benning L, Wentz E, Adedimeji A, Wilson TE, et al. Longitudinal Associations Between Neighborhood Factors and HIV Care Outcomes in the WIHS. AIDS Behav. 2020;24(10):2811–8.

    Article  Google Scholar 

  17. Wiewel EW, Borrell LN, Jones HE, Maroko AR, Torian LV. Neighborhood Characteristics Associated with Achievement and Maintenance of HIV Viral Suppression Among Persons Newly Diagnosed with HIV in New York City. AIDS Behav. 2017;21(12):3557–66.

    Article  Google Scholar 

  18. Vaughan AS, Rosenberg E, Shouse RL, Sullivan PS. Connecting race and place: a county-level analysis of White, Black, and Hispanic HIV prevalence, poverty, and level of urbanization. Am J Public Health. 2014;104(7):e77–84.

    Article  Google Scholar 

  19. Florida Department of Health. HIV Data Center: HIV Care Data 2020 [Available from: http://www.floridahealth.gov/diseases-and-conditions/aids/surveillance/index.html.

  20. Centers for Disease Control and Prevention. Monitoring selected national HIV prevention and care objectives by using HIV surveillance data—United States and 6 dependent areas, 2018. HIV Surveillance Supplemental Report 2021.

  21. Florida Department of Health. HIV Patient Care. Ryan White Part B 2021 [Available from: http://www.floridahealth.gov/diseases-and-conditions/aids/patient-care/index.html.

  22. U.S. Department of Health and Human Services. HIV National Strategic Plan for the United States: A Roadmap to End the Epidemic 2021–2025. Washington, DC.; 2021.

  23. Sheehan DM, Fennie KP, Mauck DE, Maddox LM, Lieb S, Trepka MJ. Retention in HIV Care and Viral Suppression: Individual- and Neighborhood-Level Predictors of Racial/Ethnic Differences, Florida, 2015. AIDS Patient Care STDS. 2017;31(4):167–75.

    Article  Google Scholar 

  24. Valdiserri R, Forsyth A, Yakovchenko V, Koh H. Measuring what matters: development of standard HIV core indicators across the U.S. Department of Health and Human Services. Public health reports (Washington, DC: 1974). 2013;128(5).

  25. USDA. United States Department of Agriculture Economic Research Service-. Rural-Urban Commuting Area Codes 2021 [Available from: https://www.ers.usda.gov/data-products/rural-urban-commuting-area-codes.aspx.

  26. Kind A, Buckingham W. Making Neighborhood-Disadvantage Metrics Accessible - The Neighborhood Atlas. The New England journal of medicine. 2018;378(26):2456–2458.

  27. Rural Health Information Hub. What is Rural? 2021 [Available from: https://www.ruralhealthinfo.org/topics/what-is-rural.

  28. Centers for Disease Control and Prevention NCfHA. Selected National HIV, Prevention and Care Outcomes. https://www.cdc.gov/hiv/pdf/library/slidesets/cdc-hiv-prevention-and-care-outcomes-2018.pdf2018 [.

  29. Nagin D. Group-Based Trajectory Modeling: An Overview. Annals of Nutrition and Metabolism. 2014;65(2–3):205–10.

    Article  CAS  Google Scholar 

  30. Nagin D, Odgers C. Group-based trajectory modeling in clinical research. Annual review of clinical psychology. 2010;6:109–138.

  31. Jones B, DS N. K R. A SAS Procedure Based on Mixture Models for Estimating Developmental Trajectories. Sociol Methods Res. 2001;29(3):374–93.

    Article  Google Scholar 

  32. Andruff F, Carraro N, Thompson A, Gaudreau F. Latent Class Growth Modelling: A Tutorial. Tutorials in Quantitative Methods for Psychology. 2009;5(1):11–24.

    Article  Google Scholar 

  33. Reekie J, Mocroft A, Sambatakou H, Machala L, Chiesi A, van Lunzen J, et al. Does less frequent routine monitoring of patients on a stable, fully suppressed cART regimen lead to an increased risk of treatment failure? AIDS. 2008;22(17):2381–90.

    Article  Google Scholar 

  34. Mutasa-Apollo T, Ford N, Wiens M, Socias ME, Negussie E, Wu P, et al. Effect of frequency of clinic visits and medication pick-up on antiretroviral treatment outcomes: a systematic literature review and meta-analysis. J Int AIDS Soc. 2017;20(Suppl 4):21647.

    Article  Google Scholar 

  35. Platt L, Xu A, Giddy J, Bogart LM, Boulle A, Parker RA, et al. Identifying and predicting longitudinal trajectories of care for people newly diagnosed with HIV in South Africa. PLoS ONE. 2020;15(9):e0238975.

    Article  CAS  Google Scholar 

  36. Duff P, Shannon K, Braschel M, Ranville F, Kestler M, Elwood Martin R, et al. HIV viral load trajectories of women living with HIV in Metro Vancouver, Canada. Int J STD AIDS. 2021;32(4):322–30.

    Article  Google Scholar 

  37. Ford N, Migone C, Calmy A, Kerschberger B, Kanters S, Nsanzimana S, et al. Benefits and risks of rapid initiation of antiretroviral therapy. AIDS. 2018;32(1):17–23.

    Article  Google Scholar 

  38. Koenig SP, Dorvil N, Dévieux JG, Hedt-Gauthier BL, Riviere C, Faustin M, et al. Same-day HIV testing with initiation of antiretroviral therapy versus standard care for persons living with HIV: A randomized unblinded trial. PLoS Med. 2017;14(7):e1002357.

    Article  Google Scholar 

  39. Florida Department of Health. HIV/AIDS- Florida’s Plan to Eliminate HIV Transmission and Reduce HIV-Related Deaths http://www.floridahealth.gov/diseases-and-conditions/aids/index.html#Provide_Rapid_Access2022 [Available from: http://www.floridahealth.gov/diseases-and-conditions/aids/index.html#Provide_Rapid_Access.

  40. Tripathi A, Youmans E, Gibson JJ, Duffus WA. The impact of retention in early HIV medical care on viro-immunological parameters and survival: a statewide study. AIDS Res Hum Retroviruses. 2011;27(7):751–8.

    Article  Google Scholar 

  41. Gebrezgi MT, Fennie KP, Sheehan DM, Ibrahimou B, Jones SG, Brock P, et al. Developing a triage tool for use in identifying people living with HIV who are at risk for non-retention in HIV care. Int J STD AIDS. 2020;31(3):244–53.

    Article  Google Scholar 

  42. Samandari T, Wiener J, Huang YA, Hoover KW, Siddiqi AE. Impact of viral suppression among persons with HIV upon estimated HIV incidence between 2010 and 2015 in the United States. PLoS ONE. 2020;15(10):e0240727.

    Article  CAS  Google Scholar 

  43. Yasin F, Rizk C, Taylor B, Barakat LA. Substantial gap in primary care: older adults with HIV presenting late to care. BMC Geriatr. 2020;20(1):438.

    Article  Google Scholar 

  44. Gebrezgi MT, Sheehan DM, Mauck DE, Fennie KP, Ibanez GE, Spencer EC, et al. Individual and neighborhood predictors of retention in care and viral suppression among Florida youth (aged 13–24) living with HIV in 2015. Int J STD AIDS. 2019;30(11):1095–104.

    Article  CAS  Google Scholar 

  45. Hogan JW, Galai N, Davis WW. Modeling the Impact of Social Determinants of Health on HIV. AIDS Behav. 2021;25(Suppl 2):215–24.

    Article  Google Scholar 

  46. Sullivan PS, Denniston M, Mokotoff E, Buskin S, Broyles S, McNaghten AD. Quality of care for HIV infection provided by Ryan White Program-supported versus Non-Ryan White Program-supported facilities. PLoS ONE. 2008;3(9):e3250.

    Article  Google Scholar 

  47. Valverde E, Del Rio C, Metsch L, Anderson-Mahoney P, Krawczyk CS, Gooden L, et al. Characteristics of Ryan White and non-Ryan White funded HIV medical care facilities across four metropolitan areas: results from the Antiretroviral Treatment and Access Studies site survey. AIDS Care. 2004;16(7):841–50.

    Article  CAS  Google Scholar 

  48. Xavier Hall CD, Morgan E, Bundy C, Foran JE, Janulis P, Newcomb ME, et al. Substance Use Predicts Sustained Viral Suppression in a Community Cohort of Sexual and Gender Minority Youth Living with HIV. AIDS Behav. 2021;25(10)3303–3315

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Funding

This work was supported by the Florida Department of Health (contract CODRU) and the National Institute of Allergy and Infectious Diseases (NIAID) under Award Number R01AI145552 (Co-PIs: Salemi, Prosperi) and Award Number 5P30AI073961-13 (PI: Pahwa).

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Authors and Affiliations

  1. Department of Epidemiology, College of Public Health and Health Professions and College of Medicine, University of Florida, 2004 Mowry Road, PO Box 100231, 32610-0231, Gainesville, FL, United States

    Yiyang Liu, Shannan N. Rich, Mattia Prosperi & Robert L. Cook

  2. Department of Health Outcome and Biomedical Informatics, College of Medicine, University of Florida, Gainesville, FL, United States

    Khairul A. Siddiqi & Zhaoyi Chen

  3. Florida Department of Health, Bureau of Communicable Diseases, Tallahassee, FL, United States

    Emma Spencer

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  1. Yiyang Liu
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Contributions

YL, RC, and MP designed the study concept, and YL performed analysis. YL led the manuscript writing with help from SR, KS, and ZC. All authors helped to interpret the results and provided critical feedback.

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Correspondence to Yiyang Liu.

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The study has been approved by the University of Florida Institutional Review Board (IRB) and Florida Department of Health IRB.

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Liu, Y., Rich, S.N., Siddiqi, K.A. et al. Longitudinal trajectories of HIV care engagement since diagnosis among persons with HIV in the Florida Ryan White program. AIDS Behav 26, 3164–3173 (2022). https://doi.org/10.1007/s10461-022-03659-9

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