Background Poor retention in HIV care is associated with worse clinical outcomes and increased HIV transmission. We examined the relationship between self-reported alcohol use, a potentially modifiable behavior, and retention. Methods 9,694 people living with HIV (PLWH) from 7 participating U.S. HIV clinical sites (the CFAR Network of Integrated Clinical Systems (CNICS)) contributed 23,225 observations from January, 2011 to June, 2014. The retention outcomes were 1) Institute of Medicine (IOM) retention: 2 visits within 1 year at least 90 days apart and 2) visit adherence (proportion of kept visits / (scheduled + kept visits)). Alcohol use was measured with AUDIT-C, generating drinking (never, moderate, heavy) and binge frequency (never, monthly/less than monthly, weekly/daily) categories. Adjusted multivariable logistic models, accounting for repeat measures, were generated. Results 82% of our sample was male, 46% white, 35% black, and 14% Hispanic. At first assessment, 37% of participants reported never drinking, 38% moderate, and 25% heavy, and 89% of the patients were retained (IOM retention measure). Participants’ mean (SD) visit adherence was 84% (25%). Heavy alcohol use was associated with inferior IOM defined retention (adjusted OR (aOR) 0.78, 95% CI 0.69, 0.88), and daily/weekly binge drinking was associated with lower visit adherence (aOR=0.90, 95% CI 0.82, 0.98). Conclusions Both heavy drinking and frequent binge drinking were associated with worse retention in HIV care. Increased identification and treatment of heavy and binge drinking in HIV clinical care settings may improve retention in HIV care, with downstream effects of improved clinical outcomes and decreased HIV transmission.

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This study aims to describe patients' and families' perspectives regarding the ideal role and responsibilities of a health coach to facilitate pediatric weight management in the primary care setting. Systematic thematic analysis of semistructured interviews with overweight children and their parents was performed. The majority of participants self-identified as racial/ethnic minorities and were Medicaid eligible. Desired health coaching elements included ( a) customized support and encouragement, including goal setting and maintenance, cultural sensitivity, and consideration of budget and lifestyle; ( b) nutritional guidance, including meal planning, assistance obtaining healthy food, and education and counseling; and ( c) linkage to resources, including social services, physical activity support, and programs for children with special health care needs. We conclude that families' specific needs should be holistically considered in the design of health coaching programs targeting pediatric obesity. Such support may help overcome social and financial barriers to changing health behaviors related to weight management.