Past Care Predicts Future Care in Out-of-Care People Living with HIV: Results of a Clinic-Based Retention-in-Care Intervention in North Carolina
Poor retention in care is associated with higher viral load (VL) results and decreased rates of viral load suppression (VS) in people living with HIV (PLWH). Therefore, improving retention in HIV care is a priority of national significance. The NC-LINK Retention Project utilized a systematic approach to identify, locate, and attempt to return to care patients who did not attend a clinic appointment for 6–9 months. Clinical and surveillance data were used to evaluate associations between patient characteristics and VL outcomes. Between January 1, 2013 and December 31, 2014, 1118 patients at participating clinics were identified as out-of-care and referred to retention staff. Of these, 712 (64%) were located in North Carolina. Patients with recent prior medical care (aPR 1.43, 95% CI 1.25, 1.66) and recent VS (aPR 1.28, 95% CI 1.16, 1.41) were more likely to be located. Of located patients, 58% re-engaged in care within 90 days of retention referral. Patients who achieved VS within 180 days were more likely to be 40–49 years (aPR 1.19 95% CI 1.01–1.40; compared with 18–29 age group), had insurance at their last visit (aPR 1.19 95% CI 1.01–1.77), had a care visit in the prior year (aPR 1.37 95% CI 1.05–1.77), and had VS at the prior care visit (aPR 2.54 95% CI 1.98–3.25). Clinic-based retention efforts may be effective at helping PLWH decrease out-of-care periods, but prior patterns of care usage persist.
KeywordsRetention in care HIV care Out-of-care
All authors have made a contribution to the manuscript work, analysis, writing or editing and accept responsibility for publication. The authors also acknowledges the clinic staff, providers, and patients for their invaluable contributions to this research.
This research was supported by funds from HRSA’s Special Projects of National Significance Initiative: Systems Linkages (H97HA22695). The authors have no conflicts of interest to report. This study was conducted with the approval of the Institutional Review Board. The program was implemented as clinical care and did not require written consent. Written consent was obtained for focus groups and interviews. The authors also acknowledge the clinic staff, providers, and patients for their invaluable contributions to this research. The content is solely the responsibility of the authors and does not necessarily represent the official views of the Health Resources and Services Administration.
Compliance with Ethical Standards
Conflict of interest
A Wilkin receives research funding from Gilead, Janssen, Pfizer. All other authors report no real or perceived vested interests that relate to this article that could be construed as a conflict of interest.
Ethical Approval for Human Subjects
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.
Ethical Approval for Animal Research
This article does not contain any studies with animals performed by any of the authors.
- 14.HIV Care Outcomes in North Carolina, 2016. North Carolina HIV/STD/Hepatitis Surveillance Unit Communicable Disease Branch. 2017. http://epi.publichealth.nc.gov/cd/stds/figures/factsheet_HIV_care_outcomes_2016_rev3.pdf. Accessed 22 Nov 2017.
- 16.Kempf MC, McLeod J, Boehme AK, Walcott MW, Wright L, Seal P, et al. A qualitative study of the barriers and facilitators to retention-in-care among HIV-positive women in the rural southeastern United States: implications for targeted interventions. AIDS Patient Care STDS. 2010;24(8):515–20.CrossRefPubMedGoogle Scholar
- 20.Reif SS, Wilson E, McAllaster C. HIV stigma study in the deep south: descriptive findings. Southern HIV/AIDS Strategy Initiative. 2017. https://southernaids.files.wordpress.com/2017/08/revised-stigma-report-formatted-in-pdf.pdf. Accessed 27 Jan 2018.
- 27.Thompson MA, Mugavero MJ, Amico KR, Cargill VA, Chang LW, Gross R, et al. Guidelines for improving entry into and retention in care and antiretroviral adherence for persons with HIV: evidence-based recommendations from an International Association of Physicians in AIDS Care panel. Ann Intern Med. 2012;156(11):817-33, W-284, W-285, W-286, W-287, W-288, W-289, W-290, W-291, W-292, W-293, W-294.Google Scholar
- 30.Swygard H, Seña AC, Mobley V, Glenn K, Keller JE, Sampson LA, Heine A, Klein E, Berger M, Sullivan KA, Clymore J, Quinlivan EB. Connections to HIV care using a modified ARTAS program and a statewide team. In: 10th International Conference on HIV Treatment and Prevention Adherence; Miami, FL2015.Google Scholar
- 31.Seña AC, Donovan J, LeViere A, Swygard H, Clymore J, Mobley V, Sullivan K, Willis S, Heine A, Quinlivan EB. Outcomes from the “NC LINK” program: a statewide approach to HIV linkage and re-engagement to care in North Carolina. In: 11th International Conference on HIV Treatment and Prevention Adherence; Ft. Lauderdale, FL2016.Google Scholar