Living with HIV But Without Medical Care: Barriers to Engagement

Access to sustained HIV medical care is critical to achieving viral suppression. However, a variety of factors may impede or facilitate retention in care or becoming virally suppressed. Though retention and suppression are often treated separately, this study examined both in a cohort of 921 HIV + women of color who participated in eight demonstration programs across the US. For women who met the inclusion criteria, 83% (n = 587) were retained and 73% (n = 357) were virally suppressed. Average age of women retained was 40.9, and 41.9 for those virally suppressed. The majority were African American/Black or Hispanic/Latina, single, and had no children less than 18 years of age, had health insurance, a high school degree or higher, were stably housed, and unemployed. Some factors associated with retention in care were indecision about seeking HIV medical care (AOR = 0.42) and having children under the age of 18 (AOR = 0.59). Some factors associated with being virally suppressed were living with others (AOR = 0.58), current substance abuse (AOR = 0.38), and fair/poor health (AOR = 0.40). The findings suggest different processes and social mechanisms may influence retention and viral suppression. Interventions seeking to improve retention in care may require tailored program components and strategies that focus on improving viral suppression.

Section: Discussionmentioning

confidence: 99%

“…Though there are numerous studies examining factors associated with retention in care or viral suppression, 11,[16][17][18][19][20] fewer examine both in a single study. 11,21 A few studies focus on women exclusively, but are more focused on HIV acquisition, 22 and none focus on WOC who are disproportionally affected by HIV/AIDS.…”

mentioning

confidence: 99%

Factors Associated with Retention and Viral Suppression Among a Cohort of HIV+ Women of Color

Blank

Fletcher

Verdecias

et al. 2015

“…The presence or absence of integrated care might differentially impact care access in other settings. 11,22 Alternatively, other factors among KPNC patients might lower their risk of mortality despite missing some visits. For example, homelessness is associated with decreased access to medical care, but is not a significant issue among our patients.…”

Section: Discussionmentioning

confidence: 99%

Missed Office Visits and Risk of Mortality Among HIV-Infected Subjects in a Large Healthcare System in the United States

Horberg

Hurley

Silverberg

et al. 2013

100

Linkage and retention in care soon after HIV diagnosis improves clinical outcomes. Conversely, missed visits after diagnosis are associated with increased mortality in the public care setting. We analyzed mortality among newly diagnosed HIV patients ‡ 18 years old in a large private care setting between 01/01/1997 and 12/31/ 2009, comparing patients who missed visits in their first year following diagnosis (index period) with those who did not. Patients who died during the index period were excluded. Hazard ratios (HR) for association of missed visits and mortality were obtained by Cox proportional hazards regression, adjusting for patient demographics, CD4 + counts, and AIDS-defining conditions (CDC, 1993) at diagnosis. We also evaluated risk factors of missed visits by multivariable logistic regression. 2811 patients were included, of whom 65% had ‡ 1 missed visit, and 226 patients died during follow-up. Patients with ‡ 1 missed visit had a 71% increased mortality risk (HR = 1.71, p = 0.001) with 12% increased rate per missed visit (HR = 1.12, p < 0.001). Factors associated with missed visits were younger age (OR = 1.69 compared to 60 + years), Black and Latino race/ethnicity (OR = 1.54, 1.48 respectively, compared to Caucasians), injection drug use (OR = 2.50 compared to men who have sex with men), and lower CD4 + (OR = 1.43 for CD4 + 100-199 cells/lL, OR = 1.39 for 50-99 cells/lL, and OR = 1.63 for CD4 + < 50 cells/lL, compared with CD4 + > 500 cells/lL). In an insured patient population, missed visits in the first year of HIV care are common and associated with increased mortality. Early retention in HIV care is critical to improving outcomes.

“…[40][41][42] Some studies using different age ranges for analysis found no difference in linkage in younger adults. 35,[43][44][45] However, combining published data from these studies (Table 1), we estimate that 62% of newly diagnosed HIV-infected adolescents and young adults in the United States link to care within the first 6-12 months.…”

Section: Linkage To Carementioning

confidence: 99%

The Adolescent and Young Adult HIV Cascade of Care in the United States: Exaggerated Health Disparities

Zanoni

Mayer²

2014

359

315

Little is known about how adolescents and young adults contribute to the declines in the cascade of care from HIV-1 diagnosis to viral suppression. We reviewed published literature from the Unites States reporting primary data for youth (13-29 years of age) at each stage of the HIV cascade of care. Approximately 41% of HIVinfected youth in the United States are aware of their diagnosis, while only 62% of those diagnosed engage medical care within 12 months of diagnosis. Of the youth who initiate antiretroviral therapy, only 54% achieve viral suppression and a further 57% are not retained in care. We estimate less than 6% of HIV-infected youth in the United States remain virally suppressed. We explore the cascade of care from HIV diagnosis through viral suppression for HIV-infected adolescents and young adults in the United States to highlight areas for improvement in the poor engagement of the infected youth population.