Retention in HIV care depends on patients’ perceptions of the clinic experience

Wessinger, Matthew H.; Hennink, Monique; Kaiser, Bonnie N.; Mangal, Jed P.; Gokhale, Runa; Ruchin, Lauren; Moanna, Abeer; Rimland, David; Farber, Eugene W.; Marconi, Vincent C.

doi:10.1080/09540121.2017.1308465

Cited by 9 publications

(7 citation statements)

References 9 publications

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“…Nonetheless, those who were retained were the ones who did report use of hormones for gender-affirmation, which constitutes the first contact or the entrance to the healthcare system. Additionally, older TGW could have more confidence in the healthcare team and a better and more trustworthy patient-provider relationship, which contribute to improved retention [33]. Even though substance use has been identified as a factor that negatively affects retention among TGW [34], in our study, the use of alcohol and cocaine in the last year was not significantly associated with retention.…”

Section: Plos Onecontrasting

confidence: 58%

Retention among transgender women treated with dolutegravir associated with tenofovir/lamivudine or emtricitabine in Argentina: TransViiV study

et al. 2023

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In Argentina, transgender women (TGW) have a high HIV prevalence (34%). However, this population shows lower levels of adherence, retention in HIV care and viral suppression than cisgender patients. The World Health Organization (WHO) recommends the transition to dolutegravir (DTG)-based regimens to reduce adverse events and improve adherence and retention. The purpose of this study was to determine retention, adherence and viral suppression in naïve TGW starting a DTG-based first-line antiretroviral treatment (ART) and to identify clinical and psychosocial factors associated with retention. We designed a prospective, open-label, single-arm trial among ART-naïve HIV positive TGW (Clinical Trial Number: NCT03033836). Participants were followed at weeks 4, 8, 12, 24, 36 and 48, in a trans-affirmative HIV care service that included peer navigators, between December, 2015 and May, 2019. Retention was defined as the proportion of TGW retained at week 48 and adherence was self-reported. Viral suppression at <50 copies/mL was evaluated using snapshot algorithm and as per protocol analysis. Of 75 TGW screened, 61 were enrolled. At baseline, median age was 28 y/o., HIV-1-RNA (pVL) 46,908 copies/mL and CD4+ T-cell count 383 cells/mm3. At week 48, 77% were retained and 72% had viral suppression (97% per protocol). The regimen was well tolerated and participants reported high adherence (about 95%). Eleven of the fourteen TGW who discontinued or were lost to follow-up had undetectable pVL at their last visit. Older age was associated with better retention. DTG-based treatment delivered by a trans-competent team in a trans-affirmative service was safe and well tolerated by TGW and associated with high retention, high adherence and high viral suppression at 48 weeks among those being retained.

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Section: Plos Onecontrasting

confidence: 58%

Retention among transgender women treated with dolutegravir associated with tenofovir/lamivudine or emtricitabine in Argentina: TransViiV study

et al. 2023

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“…Other individual factors such as mental illness and perceived stigma [32,33] or aspects related to health care services and external environment [23,32] may also play a key role in retention in HIV care in Belgium. For example, a confident relationship with the HIV care provider and a facilitating health care structure, with features such as ease of reach by phone, ease of appointment taking, extended hours of consultation, automatic text messages or pre-consultation reminder phone calls and a positive waiting room experience, have frequently been reported as facilitators [12,[33][34][35][36].…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2020

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Objectives We aimed to study the incidence rate, predictors and outcomes of HIV care interruption (HCI) in Belgium. Methods We analysed data for adult patients with at least two HIV care records in the Belgian HIV cohort between 1 January 2007 and 31 December 2016. An HCI episode was defined as 1 year without an HIV care record. The HCI incidence rate was analysed using Poisson regression, return to HIV care using a cumulative incidence function with death as a competing risk, and viral load (VL) status upon return to HIV care using logistic regression. Results We included 16 066 patients accounting for 78 625 person‐years of follow‐up. The incidence rate of HCI was 5.3/100 person‐years [95% confidence interval (CI) 5.1–5.4/100 person‐years]. The incidence of return to HIV care after HCI was estimated at 77.5% (95% CI 75.7–79.2%). Of those who returned to care, 43.7% had a VL ≤ 200 HIV‐1 RNA copies/mL, suggesting care abroad or suboptimal care (without an HIV‐related care record) in Belgium during the HCI, and 56.3% returned without controlled VL and were therefore considered as having experienced a real gap in HIV care; they represented 2.3/100 person‐years of follow‐up. Factors individually associated with HCI were no antiretroviral therapy (ART) uptake, lower age, injecting drug use, non‐Belgian nationality, male gender, not being a man who has sex with men, a shorter time since HIV diagnosis, no high blood pressure and CD4 count < 350 cells/µL. Conclusions This study highlights the need to investigate return to care and viral status at return, to better understand HCI. Identified predictors can help health care workers to target patients at higher risk of HCI for awareness and support.

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“…The review did not, however, examine the role of gendered health considerations in satisfaction with care or the relative importance of different features of care by gender. This gendered lens is critical as perceptions of the clinic environment and care providers impact engagement with care among women living with HIV [ 9 ]. Meanwhile negative experiences, including experiencing or anticipating stigma and discrimination, are associated with poorer engagement in HIV care and adherence to ART [ 10 , 11 ].…”

Section: Introductionmentioning

confidence: 99%

Factors and Priorities Influencing Satisfaction with Care among Women Living with HIV in Canada: A Fuzzy Cognitive Mapping Study

Skerritt

Kaida

Savoie

et al. 2022

JPM

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Engagement along the HIV care cascade in Canada is lower among women compared to men. We used Fuzzy Cognitive Mapping (FCM), a participatory research method, to identify factors influencing satisfaction with HIV care, their causal pathways, and relative importance from the perspective of women living with HIV. Building from a map of factors derived from a mixed-studies review of the literature, 23 women living with HIV in Canada elaborated ten categories influencing their satisfaction with HIV care. The most central and influential category was “feeling safe and supported by clinics and healthcare providers”, followed by “accessible and coordinated services” and “healthcare provider expertise”. Participants identified factors that captured gendered social and health considerations not previously specified in the literature. These categories included “healthcare that considers women’s unique care needs and social contexts”, “gynecologic and pregnancy care”, and “family and partners included in care.” The findings contribute to our understanding of how gender shapes care needs and priorities among women living with HIV.

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Retention in HIV care depends on patients’ perceptions of the clinic experience

Cited by 9 publications

References 9 publications

Retention among transgender women treated with dolutegravir associated with tenofovir/lamivudine or emtricitabine in Argentina: TransViiV study

Retention among transgender women treated with dolutegravir associated with tenofovir/lamivudine or emtricitabine in Argentina: TransViiV study

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

Factors and Priorities Influencing Satisfaction with Care among Women Living with HIV in Canada: A Fuzzy Cognitive Mapping Study

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