People with diagnosed HIV infection not attending for specialist clinical care: UK national review

Abstract

BackgroundRegular clinical care is important for the well-being of people with HIV. We sought to audit and describe the characteristics of adults with diagnosed HIV infection not reported to be attending for clinical care in the UK.MethodsPublic Health England (PHE) provided clinics with lists of patients diagnosed or seen for specialist HIV care in 2010 but not linked to a clinic report or known to have died in 2011. Clinics reviewed case-notes of these individuals and completed questionnaires. A nested case–control analysis was conducted to compare those who had remained in the UK in 2011 while not attending care with individuals who received specialist HIV care in both 2010 and 2011.ResultsAmong 74,418 adults living with diagnosed HIV infection in the UK in 2010, 3510 (4.7 %) were not reported as seen for clinical care or died in 2011. Case note reviews and outcomes were available for 2255 (64 %) of these: 456 (20.2 %) remained in the UK and did not attend care; 590 (26.2 %) left UK; 508 (22.6 %) received care in the UK: 73 (3.2 %) died and 628 (27.8 %) had no documented outcome. Individuals remaining in the UK and not attending care were more likely to be treatment naïve than those in care, but duration since HIV diagnosis was not significant. HIV/AIDS related hospitalisations were observed among non-attenders.ConclusionRetention in UK specialist HIV care is excellent. Our audit indicates that the ‘true’ loss to follow up rate in 2011 was <2.5 % with no evidence of health tourism. Novel interventions to ensure high levels of clinic engagement should be explored to minimise disease progression among non-attenders.

Loss to Follow-Up After Pregnancy Among Sub-Saharan Africa-Born Women Living With Human Immunodeficiency Virus in England, Wales and Northern Ireland

“…The proportion of women lost to follow-up after pregnancy reported in this article appears to be consistent with data from a previous analysis of UK surveillance data looking at attendance for HIV care in the general HIV-positive population in EW&NI, 8 but is over twice as high as the rate reported in a recent national audit of LTFU in HIV-positive adults. 10 Of note, we have also demonstrated a similar LTFU rate as that reported in a recent analysis of data on postnatal retention in care in the Swiss HIV Cohort Study. 15 Although the proportion of women we identified as lost to follow-up after pregnancy is lower than those described in most studies conducted outside the United Kingdom, it falls short of current UK standards which state that more than 95% of HIV-positive patients should access HIV services at least once a year.…”

“…7 Studies conducted in the UK looking at loss to follow-up (LTFU) at 1 year among HIV-positive adults have reported rates ranging from 2.5% to 20%, with female sex, younger age, recent diagnosis of HIV, and not being on ART associated with an increased risk of disengagement from care. 8 – 10 A consistent finding across these studies is the association between black African ethnicity and LTFU. 8 – 10 …”

“… 8 – 10 A consistent finding across these studies is the association between black African ethnicity and LTFU. 8 – 10 …”

Incidence rate, predictors and outcomes of interruption of HIV care: nationwide results from the Belgian HIV cohort

“…Other demographic predictors of HCI identified in this analysis were male gender and foreign nationality; those who were male or of foreign nationality were less likely to return to HIV care in Belgium as a consequence of higher permanent out-migration during HCI. MSM were less likely to experience HCI compared to heterosexuals, as reported in the literature [10,11,[25][26][27].…”

“…Studies on HIV care interruption (HCI) and loss to follow-up in European countries have reported incidence rates of around 2.5-3.5/100 person-years [10][11][12]. In a large multi-country European cohort study, 50% of the patients had, between 1995 and 2005, a period of > 1 year without a follow-up visit [13].…”