Predictors identified for losses to follow-up among HIV-seropositive patients

Lanoy, Émilie; Mary‐Krause, Murielle; Tattevin, Pierre; Dray‐Spira, Rosemary; Duvivier, Claudine; Fischer, Patricia; Obadia, Yolande; Costagliola, Dominique

doi:10.1016/j.jclinepi.2005.11.024

Cited by 82 publications

(103 citation statements)

References 21 publications

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“…An uncertain legal situation, with the risk of deportation through the asylum process, which has also been described in other countries, is likely to contribute to LTFU [28]. Older participants had a better retention rate, which is in accordance with other recent data [10,11,29]. Older age may be a proxy for less mobility and more comorbidity.…”

Section: Discussionsupporting

confidence: 83%

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Participation, characteristics and retention rates of HIV‐positive immigrants in the Swiss HIV Cohort Study^*

et al. 2011

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ObjectiveData from observational cohorts may be influenced by population structure and loss to follow-up (LTFU). Quality of care may be associated with participation in cohort networks. We aimed to study the participation, characteristics and retention rates of immigrants in the Swiss HIV Cohort Study (SHCS). MethodsWe compared enrolment over time (1996-1999, 2000-2003 and 2004-2008) and LTFU between individuals from different geographical regions. In 2008, we performed a cross-sectional survey to investigate the proportion of individuals not participating in the SHCS but who were in care at SHCS institutions. Predictors for LTFU were analysed using Cox proportional hazard models, and those for nonparticipation using logistic regression. ResultsA total of 7840 individuals entered the SHCS during the observation period. The proportion of immigrants increased over time, especially the proportion of women from sub-Saharan Africa, which increased from 21 to 48% during the observation period. Overall LTFU was 3.76 [95% confidence interval (CI) 3.58-3.95]/100, with the highest hazard ratio in men from sub-Saharan Africa (2.82/100 patient-years; 95% CI 2.30-3.46/100), compared with men from northwestern countries. Other predictors for LTFU were age o30 years, lower education, injecting drug use, and higher baseline CD4 cell counts. Participants taking antiretroviral therapy had reduced LTFU. The survey showed that 84% of HIV-infected patients in care at SHCS institutions were enrolled in the cohort. Nonparticipation was more likely among men from non-European regions (odds ratio 2.73; 95% CI 2.29-3.24), women from sub-Saharan Africa (odds ratio 3.01; 95% CI 2.40-3.77) and women from Latin America/Caribbean (odds ratio 2.10; 95% CI 1.30-3.39). ConclusionsNumbers of HIV-infected immigrants are increasing but they are underrepresented in the SHCS, and immigrants are more likely to be lost to follow-up.

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Section: Discussionsupporting

confidence: 83%

“…In contrast to other observational databases [11,13], the SHCS requires written informed consent which may pose a barrier to participation.…”

Section: Introductionmentioning

confidence: 99%

Participation, characteristics and retention rates of HIV‐positive immigrants in the Swiss HIV Cohort Study^*

et al. 2011

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“…Researchers have assessed retention in care in a number of different ways. [21][22][23][24][25] These measures have their own strengths and weaknesses, 26 but none of them takes into account the fact that frequency of attendance is related to changes in treatment and health status and may also be affected by external forces or changes in clinic policy. In the UK, for example, guidelines at the time the REACH study was conducted indicated that patients should be seen within 2-4 weeks of starting ART and every 3-6 months for routine monitoring on ART if they were considered 'stable', with good adherence and an undetectable viral load.…”

Section: Chapter 1 Backgroundmentioning

confidence: 99%

“…Previous studies have examined the association between engagement in HIV care, as defined by one of the measures described above, and background characteristics. Although health service provision and populations of PLWH vary from country to country, these studies suggest that PLWH are less likely to disengage from care if they are male, 8 older, 8,21,28,29 white 8,22 and men who have sex with men (MSM) 22,23 and have started ART. 8,21 Socioeconomic factors and education have been highlighted in relation to disparities in EIC 30,31 and complex patient groups, such as intravenous drug users, migrants and the newly diagnosed, are more likely to disengage from care.…”

Section: Chapter 1 Backgroundmentioning

confidence: 99%

“…8,21 Socioeconomic factors and education have been highlighted in relation to disparities in EIC 30,31 and complex patient groups, such as intravenous drug users, migrants and the newly diagnosed, are more likely to disengage from care. 23 Although recent diagnosis is associated with poor retention in care, 8 there is also an indication that EIC can diminish over time. 22 Some studies have used qualitative methods and psychometric measures to try and understand why patients do not engage with care.…”

Section: Chapter 1 Backgroundmentioning

confidence: 99%

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REACH: a mixed-methods study to investigate the measurement, prediction and improvement of retention and engagement in outpatient HIV care

Howarth

Apea

Michie

et al. 2017

Health Serv Deliv Res

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BackgroundAntiretroviral therapy (ART) benefits individuals living with human immunodeficiency virus (HIV) through reduced morbidity and mortality, and brings public health gains through a reduction in HIV transmission. People living with human immunodeficiency virus (PLWH) need to know their HIV status and engage in HIV care in order for these individual and public health benefits to be realised.ObjectiveTo explore, describe and understand HIV outpatient attendance in PLWH, in order to develop cost-effective interventions to optimise engagement in care.DesignA mixed-methods study incorporating secondary analysis of data from the UK Collaborative HIV Cohort (UK CHIC) study and primary data collection.MethodsPhase 1 – an engagement-in-care (EIC) algorithm was developed to categorise patients as in care or out of care for each month of follow-up. The algorithm was used in group-based trajectory analysis to examine patterns of attendance over time and of the association between the proportion of months in care before ART initiation and post-ART mortality and laboratory test costs. Phase 2 – a cross-sectional survey was conducted among patients attending seven London HIV clinics. Regular attenders (all appointments attended in past year), irregular attenders (one or more appointments missed in past year) and non-attenders (recent absence of ≥ 1 year) were recruited. A ‘retention risk tool’ was developed to identify those at risk of disengaging from care. Individual in-depth interviews and focus groups were conducted with PLWH. Phase 3 – key informant interviews were conducted with HIV service providers. Interventions were developed from the findings of phases 2 and 3.ResultsPlots from group-based trajectory analysis indicated that four trajectories best fitted the data. Higher EIC is associated with reduced mortality but the association between EIC before starting ART, and post-ART mortality [relative hazard (RH) per 10% increase in EIC 0.29, 95% confidence interval (CI) 0.18 to 0.47] was attenuated after adjustment for fixed covariates and post-ART cluster of differentiation 4 counts and viral loads (RH 0.74, 95% CI 0.42 to 1.30). Small differences were found in pre-ART EIC and the costs of post-ART lab tests. The final model for the retention risk tool included age at diagnosis, having children, recreational drug use, drug/alcohol dependency, insufficient money for basic needs and use of public transport to get to the clinic. Quantitative and qualitative data showed that a range of psychological, social and economic issues were associated with disengagement from care. The negative impact of stigma on attendance was highlighted. Interventions were proposed that support a holistic approach to care including peer support, address stigma by holding clinics in alternative locations and involve training staff to encourage attendance.ConclusionsThe study shows the adverse health impacts of disengaging from HIV care and demonstrates the importance of the wider health and social context in managing HIV effectively. Although phase 1 analysis was based on UK data, phases 2 and 3 were limited to London. The interventions proposed are supported by the data but their cost-effectiveness requires testing. Future research is needed to evaluate the interventions, to validate our retention risk tool across populations and settings, and to fully analyse the economic costs of disengaging from HIV care.FundingThe National Institute for Health Research Health Services and Delivery Research programme. The UK CHIC study is funded by the Medical Research Council UK (grant numbers G0000199, G0600337, G0900274 and M004236).

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HIV Care for Geographically Mobile Populations

Taylor

Garduño

Reyes

et al. 2011

Mount Sinai J Medicine

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The interaction between mobility and HIV risk is well recognized, but what happens to those same individuals, once infected, as they transition to living with HIV? Does mobility affect their transition into HIV care? If so, do mobile and non-mobile populations achieve similar success with HIV treatment?The definition of mobility has changed over the centuries to encompass a complex phenotype including permanent migration, frequent travel, circular migration, and distance from HIV treatment centers. The heterogeneity of these definitions leads to discordant findings. Investigations show that mobility has an impact on HIV risk, but fewer data exist on the impact of geographic mobility on HIV care and treatment.This review will examine existing data on the impact of geographic mobility on access to and maintenance in HIV care and on adherence to antiretroviral therapy. It will also expand the concept of mobility to include data on the impact of the distance from residence to clinic on HIV care and treatment adherence.Our conclusions are that the existing literature is limited by varying definitions of mobility and the inherent oversimplification necessary to apply a "mobility measure" in a statistical analysis. The impact of mobility on HIV treatment outcomes deserves further exploration to both define the phenomenon and target interventions to these at-risk populations.

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Predictors identified for losses to follow-up among HIV-seropositive patients

Cited by 82 publications

References 21 publications

Participation, characteristics and retention rates of HIV‐positive immigrants in the Swiss HIV Cohort Study^*

Participation, characteristics and retention rates of HIV‐positive immigrants in the Swiss HIV Cohort Study^*

REACH: a mixed-methods study to investigate the measurement, prediction and improvement of retention and engagement in outpatient HIV care

HIV Care for Geographically Mobile Populations

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Predictors identified for losses to follow-up among HIV-seropositive patients

Cited by 82 publications

References 21 publications

Participation, characteristics and retention rates of HIV‐positive immigrants in the Swiss HIV Cohort Study*

Participation, characteristics and retention rates of HIV‐positive immigrants in the Swiss HIV Cohort Study*

REACH: a mixed-methods study to investigate the measurement, prediction and improvement of retention and engagement in outpatient HIV care

HIV Care for Geographically Mobile Populations

Contact Info

Product

Resources

About

Participation, characteristics and retention rates of HIV‐positive immigrants in the Swiss HIV Cohort Study^*

Participation, characteristics and retention rates of HIV‐positive immigrants in the Swiss HIV Cohort Study^*