Geographic Variations in Retention in Care among HIV-Infected Adults in the United States

Public Deposited
Analytics

Downloadable Content

Download PDF
Request Version for Screen Reader
Creator
  • Rebeiro, Peter F.
    • Other Affiliation: Vanderbilt University School of Medicine
  • Gange, Stephen J.
    • Other Affiliation: Johns Hopkins University
  • Horberg, Michael A.
    • Other Affiliation: Mid-Atlantic Permanente Research Institute; Kaiser Permanente Mid-Atlantic States
  • Abraham, Alison G.
    • Other Affiliation: Johns Hopkins University
  • Napravnik, Sonia
    • Affiliation: University of North Carolina at Chapel Hill
  • Samji, Hasina
    • Other Affiliation: British Columbia Centre for Excellence in HIV/AIDS
  • Yehia, Baligh R.
    • Other Affiliation: University of Pennsylvania; Perelman School of Medicine
  • Althoff, Keri N.
    • Other Affiliation: Johns Hopkins University
  • Moore, Richard D.
    • Other Affiliation: Johns Hopkins University
  • Kitahata, Mari M.
    • Other Affiliation: University of Washington School of Medicine
  • Sterling, Timothy R.
    • Other Affiliation: Vanderbilt University School of Medicine
  • Curriero, Frank C.
    • Other Affiliation: Johns Hopkins University
  • Boswell, Stephen
    • Other Affiliation: Fenway Health HIV Cohort
  • Grasso, Chris
    • Other Affiliation: Fenway Health HIV Cohort
  • Mayer, Kenneth H.
    • Other Affiliation: Fenway Health HIV Cohort
  • Brooks, John T.
    • Other Affiliation: HIV Outpatient Study
  • Buchacz, Kate
    • Other Affiliation: HIV Outpatient Study
  • Gebo, Kelly A.
    • Other Affiliation: HIV Research Network
  • Rodriguez, Benigno
    • Other Affiliation: John T. Carey Special Immunology Unit Patient Care and Research Database; Case Western Reserve University
  • Silverberg, Michael J.
    • Other Affiliation: Kaiser Permanente Northern California
  • Saag, Michael S.
    • Other Affiliation: University of Alabama at Birmingham; Clinic Cohort
  • Mugavero, Michael J.
    • Other Affiliation: University of Alabama at Birmingham; Clinic Cohort
  • Willig, James
    • Other Affiliation: University of Alabama at Birmingham; Clinic Cohort
  • Eron, Joseph J.
    • Affiliation: University of North Carolina at Chapel Hill
  • Crane, Heidi M.
    • Other Affiliation: University of Washington HIV Cohort
  • Justice, Amy C.
    • Other Affiliation: Veterans Aging Cohort Study
  • Dubrow, Robert
    • Other Affiliation: Veterans Aging Cohort Study
  • Fiellin, David
    • Other Affiliation: Veterans Aging Cohort Study
  • Haas, David
    • Other Affiliation: Vanderbilt-Meharry Center for AIDS Research Cohort
  • Bebawy, Sally
    • Other Affiliation: Vanderbilt-Meharry Center for AIDS Research Cohort
  • Turner, Megan
    • Other Affiliation: Vanderbilt-Meharry Center for AIDS Research Cohort
Abstract
  • ObjectiveTo understand geographic variations in clinical retention, a central component of the HIV care continuum and key to improving individual- and population-level HIV outcomes.DesignWe evaluated retention by US region in a retrospective observational study.MethodsAdults receiving care from 2000–2010 in 12 clinical cohorts of the North American AIDS Cohort Collaboration on Research and Design (NA-ACCORD) contributed data. Individuals were assigned to Centers for Disease Control and Prevention (CDC)-defined regions by residential data (10 cohorts) and clinic location as proxy (2 cohorts). Retention was ≥2 primary HIV outpatient visits within a calendar year, >90 days apart. Trends and regional differences were analyzed using modified Poisson regression with clustering, adjusting for time in care, age, sex, race/ethnicity, and HIV risk, and stratified by baseline CD4+ count.ResultsAmong 78,993 adults with 444,212 person-years of follow-up, median time in care was 7 years (Interquartile Range: 4–9). Retention increased from 2000 to 2010: from 73% (5,000/6,875) to 85% (7,189/8,462) in the Northeast, 75% (1,778/2,356) to 87% (1,630/1,880) in the Midwest, 68% (8,451/12,417) to 80% (9,892/12,304) in the South, and 68% (5,147/7,520) to 72% (6,401/8,895) in the West. In adjusted analyses, retention improved over time in all regions (p<0.01, trend), although the average percent retained lagged in the West and South vs. the Northeast (p<0.01).ConclusionsIn our population, retention improved, though regional differences persisted even after adjusting for demographic and HIV risk factors. These data demonstrate regional differences in the US which may affect patient care, despite national care recommendations.
Date of publication
Keyword
DOI
Identifier
Resource type
  • Article
Rights statement
  • In Copyright
Journal title
  • PloS One
Journal volume
  • 11
Journal issue
  • 1
Page start
  • e0146119
Language
  • English
ISSN
  • 1932-6203

Relations

Parents:

This work has no parents.

In Collection:

Items

Thumbnail Title Date Uploaded Visibility Actions
file details PubMedCentral-PMC4708981.pdf 2016 Public Download