Sociodemographic differences among groups of people living with HIV were found between missed- and kept-visit measures of retention in care, according to research published in AIDS Care.
Researchers conducted a cross-sectional analysis of medical record data of 10,053 patients living with HIV from 6 academically affiliated HIV clinics. Outcomes were 6 commonly used retention measures calculated for each patient during the 12-month observation period. Only scheduled visits with a primary HIV medical provider with prescribing privileges were included in calculating retention measures. Three of the measures incorporated missed visits in their calculation (missed visits-count, missed visits-dichotomized, and visit-adherence). The remaining measures were calculated solely on kept visits: the 4-month constancy measure calculated the number of 4-month intervals in which a patient had at least 1 kept visit; the 6-month gap measure captured whether a patient had >189 days between sequential kept visits; and the Institute of Medicine (IOM) measure calculated whether a patient had 2 kept visits separated by >90 days during the 12-month observation period.
Of the participants, 65% were men, 64% were black, and the mean age was 46 years. At the end of the 12-month period, approximately 63% of patients were virally suppressed. Men who had sex with men, men, and white patients living with HIV had the lowest number of missed visits (1.49, 1.61, and 1.42, respectively), while patients at risk of injected drug use (IDU) and black patients living with HIV had the highest mean number of missed visits (1.89 and 1.79, respectively).
Across all 6 measures, younger age was significantly associated with poorer retention in care. For the measures incorporating missed visits, black race and IDU transmission risk significantly predicted poorer retention. Parameter estimates for black vs white race for the 4-month visit consistency, 6-month gap, and the IOM measures suggest equivalent retention for black patients relative to white patients for kept clinic visits. However, men performed significantly worse than women on all kept-visit measures.
“Our findings suggest that missed- and kept-visit measures may be capturing different dimensions of HIV care engagement, and they raise questions about health disparities revealed in clinic-based measures of retention in care,” the authors concluded.
Batey DS, Kay ES, Westfall AO, et al; on behalf of the Retention in Care (RIC) Study Group. Are missed- and kept-visit measures capturing different aspects of retention in HIV primary care? [published online August 28, 2019]. AIDS Care. doi: 10.1080/09540121.2019.1659918