Measures of Retention in HIV Care: A Study Within a Review

Rehman, Nadia; Wu, Michael; Garcia, Cristian; Leenus, Alvin; El-Kechen, Hussein; Bhandari, M.; Zakaryan, Gohar; Zani, Babalwa; Hajizadeh, Anisa; Wang, Annie; Morassut, Rita E; Bartoszko, Jessica J; Makanjuola, Oluwatoni; Jhuti, Diya; Arora, Vaibhav; Kapoor, Andrew; Jones, Aaron; Djiadeu, Pascal; Mbuagbaw, Lawrence

doi:10.1089/apc.2022.0225

Cited by 3 publications

(9 citation statements)

References 90 publications

(214 reference statements)

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“…Due to the lack of a standard definition 22 and limited existing data on the complete HIV care continuum in rapid start, 14 we evaluated 2 different measures of retention in care. In our study, rapid start was associated with improved retention in care when measured by the current HRSA definition (one clinic visit and one viral load at least 90 days apart) but did not impact continuous retention in care (one medical visit in each 6-month period at least 60 days apart).…”

Section: Discussionmentioning

confidence: 99%

Rapid Start of Antiretroviral Therapy in a Large Urban Clinic in the US South: Impact on HIV Care Continuum Outcomes and Medication Adherence

Chow,

Gao,

Ahn

et al. 2024

J Int Assoc Provid AIDS Care

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Rapid start of antiretroviral therapy (ART) has been associated with improvement in several HIV-related outcomes in clinical trials as well as demonstration projects, but how regional and contextual differences may affect the effectiveness of this intervention necessitates further study. In this study of a large, urban, Southern US clinic-based retrospective cohort, we identified 544 patients with a new diagnosis of HIV during 2016 to 2019 and compared HIV care continuum outcomes for the first 12 months of care before and after rapid start implementation. Kaplan-Meier time-to-event curves were used to summarize time to virologic suppression, and stepwise Cox, linear, and logistic regression models were used to create multivariate models to evaluate the association between rapid start and time to virologic suppression, medication adherence, and retention in care and sustained virologic suppression, respectively. We found that rapid start was significantly associated with improved medication adherence scores (+15.37 points, 95% confidence interval [CI] 9.36-21.39, P < .01) and retention in care (adjusted odds ratio = 1.51, 95% CI 1.05-2.19, P = .03). Time to virologic suppression (median 2.46 months before, 2.56 months after rapid start) and sustained virologic suppression were not associated with rapid start in our setting. Though rapid start was associated with improved medication adherence and retention in care, more support may be needed to achieve the same outcomes seen in other studies and sustained over the entire HIV care continuum, especially in settings with significant patient and systemic barriers to care such as unstable housing, lack of Medicaid expansion, and frequent coverage interruptions.

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Section: Discussionmentioning

confidence: 99%

Rapid Start of Antiretroviral Therapy in a Large Urban Clinic in the US South: Impact on HIV Care Continuum Outcomes and Medication Adherence

Chow,

Gao,

Ahn

et al. 2024

J Int Assoc Provid AIDS Care

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“…Previously we conducted a SWAR to identify definitions of retention used in RCTs. This review showed a wide heterogeneity in the definitions of retention [18]. We anticipate that this mixed-method approach will provide the breadth and depth of the topic and will advance efforts towards a standard measure of retention in care.…”

Section: Discussionmentioning

confidence: 99%

“…The mixed method approach will comprise two phases. In the qualitative phase, we will conduct in-depth interviews building upon retention in care definitions identified in a prior review [18]. In the qualitative phase, we will explore participants’ views on measuring retention with the intent of using this information to develop a survey.…”

Section: Methodsmentioning

confidence: 99%

“…Consensus on a standard definition is compromised by the need for longitudinal assessment and the various socio-economic factors predicting retention in PLHIV [10, 16, 17]. In our recently published review of definitions of retention, we identified that trialists have used heterogeneous definitions of retention across studies [18]. This limits our ability to aggregate data for meta-analysis and to compare findings across studies.…”

Section: Introductionmentioning

confidence: 99%

“…The definition should be easy to use, record and report across different settings, healthcare systems, and populations. Arriving at a consensus for a standard definition will require views and perspectives from stakeholders involved in HIV care, including PLHIV [18].…”

Section: Introductionmentioning

confidence: 99%

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Measures of retention in HIV care: A protocol for a mixed methods study

Rehman,

Garcia,

Jones

et al. 2023

Preprint

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IntroductionRetention in HIV care is necessary to achieve adherence to antiretroviral therapy, viral load suppression, and optimal health outcomes. There is no standard definition for retention in HIV care, which compromises consistent and reliable reporting and comparison of retention across facilities, jurisdictions, and studies.ObjectiveThe objective of this study is to explore how stakeholders involved in HIV care define retention in HIV care and their preferences on measuring retention.MethodsWe will use an exploratory sequential mixed methods design involving HIV stakeholder groups such as people living with HIV, people involved in providing care for PLHIV, and people involved in decision-making about PLHIV. In the qualitative phase of the study, we with conduct 20-25 in-depth interviews to collect perspectives of HIV stakeholders on using their preferred retention measures. The interview guide has being provided as an online Supplementary Appendix 1.The findings from the qualitative phase will inform the development of survey items for the quantitative phase. Survey participants (n=385) will be invited to rate the importance of each approach to measuring retention on a seven-point Likert scale. We will merge the findings from the qualitative and quantitative findings phase to inform a consensus-building framework for a standard definition of retention in care.Ethical Issues and DisseminationThis study has received ethics approval from the Hamilton Integrated Research Ethics Board. The findings will be disseminated through peer-reviewed publications, conference presentations, and among stakeholder groups.Limitations1. This study has limitation, we won’t be able to arrive at a standard definition, a Delphi technique amongst the stakeholders will be utilized using the framework to reach a consensus globally accepted definition.

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Measures of retention in HIV care: A protocol for a mixed methods study

Rehman,

Garcia,

Jones

et al. 2024

PLoS ONE

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Introduction Retention in HIV care is necessary to achieve adherence to antiretroviral therapy, viral load suppression, and optimal health outcomes. There is no standard definition for retention in HIV care, which compromises consistent and reliable reporting and comparison of retention across facilities, jurisdictions, and studies. Objective The objective of this study is to explore how stakeholders involved in HIV care define retention in HIV care and their preferences on measuring retention. Methods We will use an exploratory sequential mixed methods design involving HIV stakeholder groups such as people living with HIV, people involved in providing care for PLHIV, and people involved in decision-making about PLHIV. In the qualitative phase of the study, we will conduct 20–25 in-depth interviews to collect the perspectives of HIV stakeholders on using their preferred retention measures. The findings from the qualitative phase will inform the development of survey items for the quantitative phase. Survey participants (n = 385) will be invited to rate the importance of each approach to measuring retention on a seven-point Likert scale. We will merge the qualitative and quantitative findings phase findings to inform a consensus-building framework for a standard definition of retention in care. Ethical issues and dissemination This study has received ethics approval from the Hamilton Integrated Research Ethics Board. The findings will be disseminated through peer-reviewed publications, conference presentations, and among stakeholder groups. Limitations This study has limitations; we won’t be able to arrive at a standard definition; a Delphi technique amongst the stakeholders will be utilized using the framework to reach a consensus globally accepted definition.

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Measures of Retention in HIV Care: A Study Within a Review

Cited by 3 publications

References 90 publications

Rapid Start of Antiretroviral Therapy in a Large Urban Clinic in the US South: Impact on HIV Care Continuum Outcomes and Medication Adherence

Rapid Start of Antiretroviral Therapy in a Large Urban Clinic in the US South: Impact on HIV Care Continuum Outcomes and Medication Adherence

Measures of retention in HIV care: A protocol for a mixed methods study

Measures of retention in HIV care: A protocol for a mixed methods study

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