Retention Challenges for a Community-Based HIV Primary Care Clinic and Implications for Intervention

Abstract

The present study sought to elucidate factors involved in loss to follow-up (LTF) among HIVinfected patients who had been receiving medical care at Fenway Community Health (FCH) located in Boston, Massachusetts. FCH provided care to 1143 HIV-infected patients in 2005, predominantly Caucasian men who have sex with men (MSM). Two approaches were used to address the research question. First, 495 patients were identified that had been LTF from [2001][2002][2003][2004][2005]. One hundred seventy-nine eligible patients completed a questionnaire to determine reasons for discontinuing care, representing a 51% response rate. Second, a cohort study was performed using the medical record data of 896 HIV-infected patients who were receiving medical care in the year 2000. Patients' utilization of primary medical care was followed until January 1, 2005 and predictors of LTF were examined using Cox proportional hazards regression modeling. Survey respondents reported that the greatest perceived barriers to care at FCH were personal/cultural, structural, and financial in nature. Twenty-two percent reported sporadic care elsewhere with gaps in care of 6 months or more, and 8% reported no regular provider for HIV. Significant predictors of LTF from regression analysis included: minority race/ethnicity, use of safety-net insurance, appointment nonadherence and no medical social work visits. To improve engagement and retention in care, organizations may use patient surveys for organizational self-assessment to effect operational changes that minimize barriers to care. A risk assessment tool based on evidence-based methods can be implemented to identify high-risk patients for innovative outreach interventions. The primary study limitation is the underrepresentation of minority and traditionally underserved populations.

Assessing the Overall Quality of Health Care in Persons Living with HIV in an Urban Environment

“…The RWP provides funding for the care of uninsured and underinsured PLWH and mandates improvements in the quality of care for PLWH. 6,9,25 In previous studies, uninsured PLWH were less likely to meet HIV-specific measures (retention in care, use of ART, and virologic suppression), [35][36][37][38][39][40][41] and nonprivate insurance was associated with more barriers to care. 42 It would therefore be expected that uninsured PLWH may meet fewer performance measures.…”

High rate of loss to clinical follow up among African HIV-infected patients attending a London clinic: a retrospective analysis of a clinical cohort

“…These differences were not explained by significant variations in definitions of LFU, as the majority defined LFU as patients who had not been seen in a clinic for at least 12 months [22-24,26-28]. …”

Challenges Facing the US Hiv/Aids Medical Care System

“…Some patients simply fail to enter outpatient care after diagnosis [13]. Others enter care but are unable to be engaged and retained in regular HIV medical care [14,15]. Others have comorbidities such as mental illness and substance abuse that severely limit their ability to access and remain in medical care.…”

“…More pressing basic subsistence needs such as food, clothing, housing, childcare or transportation, may compete with medical care priorities [16]. As alluded to above, lack of insurance (or type of insurance) presents a barrier to care and multiple studies have shown this [15,17,18]. Reasons for delays in care have been elucidated from the HIV Cost and Services Utilization Study (HCSUS), which surveyed a national probability sample.…”

“…(2008) 2(2) future science group future science group around the country designed to increase engagement and retention in care contribute to our understanding of barriers to HIV care. At one site serving a predominance of gay men and evaluating loss to follow-up, survey respondents cited personal/cultural, structural and financial issues as perceived barriers to care [15]. A total of 30% said they were dissatisfied with their primary care provider and 10 and 80% said transportation and parking were barriers, respectively.…”