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HIV Care Trajectories as a Novel Longitudinal Assessment of Retention in Care

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Abstract

Consistent engagement in care is associated with positive health outcomes among people living with HIV (PLWH). However, traditional retention measures ignore the evolving dynamics of engagement in care. To understand the longitudinal patterns of HIV care, we analyzed medical records from 2008 to 2015 of PLWH ≥ 18 years-old receiving care at a public, hospital-based HIV clinic (N = 2110). Using latent class analysis, we identified five distinct care trajectory classes: (1) consistent care (N = 1281); (2) less frequent care (N = 270); (3) return to care after initial attrition (N = 192); (4) moderate attrition (N = 163); and (5) rapid attrition (N = 204). The majority of PLWH in Class 1 (73.9%) had achieved sustained viral suppression (viral load ≤ 200 copies/mL at last test and > 12 months prior) by study end. Among the other care classes, there was substantial variation in sustained viral suppression (61.1% in Class 2 to 3.4% in Class 5). Care trajectories could be used to prioritize re-engagement efforts.

Resumen

La participación constante en el cuidado médico se asocia con resultados de salud positivos entre las personas que viven con el VIH (PVVIH). Sin embargo, las medidas de retención tradicionales no tienen en cuenta los cambios constantes en la dinámica de adherencia de los pacientes en el cuidado de su salud. Para entender los patrones longitudinales de la retención en atención médica al VIH, analizamos los registros médicos de 2110 PVVIH ≥ 18 años de edad que recibieron atención en una clínica de VIH de un hospital público entre 2008 y 2015. Utilizando un análisis de clases latentes, identificamos cinco clases distintas de trayectorias de retención en la atención: (1) retención constante (N = 1281); (2) retención menos frecuente (N = 270); (3) retorno al cuidado médico después del abandono inicial (N = 192); (4) abandono ocasional (N = 163); (5) abandono rápido (N = 205). La mayoría de las PVVIH en la Clase 1 (73.9%) alcanzaron supresión viral sostenida (carga viral ≤ 200 copias/mL en todas las cuentas virales disponibles entre 12 meses antes del final del seguimiento y en la última carga viral disponible. Entre las otras clases de adherencia, hubo una variación sustancial en la supresión viral sostenida (de 61.1% en Clase 2 a 3.4% en Clase 5). Las trayectorias de atención podrían usarse para priorizar los esfuerzos de re-integración a la atención médica.

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Acknowledgements

Funding for this study was provided by the National Institute for Allergy and Infectious Disease of the National Institutes of Health under Award No. K25AI118476 (PI: Enns). The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. The authors wish to acknowledge Allison La Pointe and Jessica Munroe at the Minnesota Department of Health for facilitating the merging of clinic data with state surveillance data and Dr. Tenko Raykov at Michigan State University for early discussions on the application of latent class methods in this analysis.

Disclosures

Funding for this study was provided by the National Institute for Allergy and Infectious Disease of the National Institutes of Health under Award No. K25AI118476 (PI: Enns). Portions of this analysis were presented at the 38th Annual Meeting of the Society for Medical Decision Making, Oct. 23–24, 2016 and at the 2018 Conference on Retroviruses and Opportunistic Infections (CROI), March 4–7, 2018.

Funding

This study was funded by the National Institute for Allergy and Infectious Disease of the National Institutes of Health under Award No. K25AI118476 (PI: Enns).

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Authors and Affiliations

  1. Division of Health Policy and Management, University of Minnesota School of Public Health, 420 Delaware St. SE, MMC 729, Minneapolis, MN, 55455, USA

    Eva A. Enns

  2. Division of Biostatistics, University of Minnesota School of Public Health, Minneapolis, MN, USA

    Cavan S. Reilly

  3. Division of Epidemiology and Community Health, University of Minnesota School of Public Health, Minneapolis, MN, USA

    Keith J. Horvath

  4. Best Practices Integrated Informatics Core, Clinical and Translational Sciences Institute, University of Minnesota, Minneapolis, MN, USA

    Karen Baker-James

  5. Division of Infectious Diseases, Hennepin County Medical Center, Minneapolis, MN, USA

    Keith Henry

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  1. Eva A. Enns
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  4. Karen Baker-James
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Correspondence to Eva A. Enns.

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Conflict of interest

Dr. Enns received an honorarium from ViiV Healthcare for participation in a technical advisory meeting unrelated to this work. Dr. Reilly declares that he has no conflict of interest. Dr. Horvath declares that he has no conflict of interest. Ms. Baker-James declares that she has no conflict of interest. Dr. Henry has received research funding unrelated to this work from Merck, Janssen, ViiV/GSK, and Gilead.

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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. This article does not contain any studies with animals performed by any of the authors.

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Informed consent was obtained from all individual participants included in the study.

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Enns, E.A., Reilly, C.S., Horvath, K.J. et al. HIV Care Trajectories as a Novel Longitudinal Assessment of Retention in Care. AIDS Behav 23, 2532–2541 (2019). https://doi.org/10.1007/s10461-019-02450-7

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