Engagement in Outpatient Care for Persons Living with HIV in the United States

Abstract

Prior studies that have assessed engagement within the various stages of care for persons living with HIV (PLWH) studied patients receiving care in HIV medical care facilities. These data are not representative of care received throughout the United States, as not all PLWH receive care in HIV clinics. This study evaluated engagement in outpatient care and healthcare utilization for PLWH, beyond facilities that specialize in HIV. Cross-sectional data were from the 2009-2010 National Hospital Ambulatory Medical Care Survey. Levels of care included receiving any care, receiving HIV-related care, established in care, engaged in care, and prescribed antiretroviral therapy (ARV). Factors associated with ARV prescription were determined by logistic regression. We analyzed data for *2.6 million outpatient clinic visits for PLWH. Of these, 90% were receiving HIV-related care, 86% were established in care, 75% were engaged in care, and 65% were prescribed ARV. In stratified analysis, the proportion of PWLH who were engaged in care varied by race/ethnicity ( p < 0.001) and ARV prescription varied significantly across the three age groups ( p = 0.004). Clinic visits within the past year did not differ for those prescribed ARV vs. not prescribed ARV [median, IQR = 3.3 visits (1.8-5.6) vs. 3.6 visits (1.3-5.9); p = 0.7]. Seeing a physician was associated with ARV prescription (OR = 0.27, 95% CI = 0.15-0.51), whereas routine engagement in care was not associated with ARV prescription (OR = 0.99, 95% CI = 0.96-1.03). Given that non-ARV-treated PLWH utilized outpatient care services at rates similar to ARV-treated PLWH, these routine clinic visits are missed opportunities for increasing ARV prescription in untreated patients.

Syphilis Testing Among Sexually Active Men Who Have Sex With Men and Who Are Receiving Medical Care for Human Immunodeficiency Virus in the United States: Medical Monitoring Project, 2013–2014

“…The higher prevalence of syphilis testing among older compared to younger MSM has been reported before [12] and may be reflecting age group disparities in retention in continuous HIV care. Studies have shown lower levels of retention in continuous HIV care among HIV-positive adolescent and young adults [19][20][21]. Older MSM in this population may have higher levels of retention in continuous HIV care and have a greater number of interactions with their HIV care provider and more opportunities to be screened for syphilis.…”

“Tweak Your Order Set!” Implementation of Modified Laboratory Order Set Improves Hepatitis C Virus Screening Rates in People Living With Human Immunodeficiency Virus

“…Limitations to the generalizability and utility of our study findings should be noted. Our clinic population had a median number of 13 visits over 2 years, which far exceeds the threshold definition of engagement in care, usually defined as having 2 visits in a year [ 18 ]. More frequent visits potentially allowed for more reminders that the patient was due for annual HCVAb testing.…”

Do Persons Living with HIV Continue to Fill Prescriptions for Antiretroviral Drugs during a Gap in Care? Analysis of a Large Commercial Claims Database

“…5,17,[21][22][23] Studies, however, have also shown that younger persons are less likely to be prescribed ART, which may account for some of the difference seen in our study. [24][25][26][27] Studies have shown mixed results regarding the proportion of persons prescribed ARV drugs, by sex. 2,24,25,27 Both younger persons and women had longer median gap length than older persons and men which may amplify the failure to fill ARV drug prescriptions during these gaps.…”

“…[24][25][26][27] Studies have shown mixed results regarding the proportion of persons prescribed ARV drugs, by sex. 2,24,25,27 Both younger persons and women had longer median gap length than older persons and men which may amplify the failure to fill ARV drug prescriptions during these gaps. Persons from the Northeast region also were more likely to never fill an ARV drug prescription during the gap.…”