Nonadherence to medical appointments is associated with increased plasma HIV RNA and decreased CD4 cell counts in a community-based HIV primary care clinic.
ABSTRACT This study examined the association of appointment nonadherence to markers of disease severity using one year of demographic and health information on 995 individuals with HIV in primary care at an urban community health centre. At the latest visit, 106 of 946 valid cases (11.2%) had a CD4 less than or equal to 200, and 454 of 936 valid cases (48.5%) had detectable plasma HIV RNA (greater than 50 copies/ml). Using logistic regression, appointment nonadherence (number of missed appointments) was a significant predictor (p < .03) of having an AIDS-defining CD4 count over and above the effects of number of kept appointments (p < .0001), and whether or not the patient was taking HAART (p < .002). Appointment nonadherence was also a significant predictor (p < .05) of having a detectable viral load over and above the effects of number of kept appointments (p < .003), HAART (p < .0001) and age (p < .004). Looking only at individuals with a detectable viral load at the earliest visit, the only significant unique predictor of improvement to an undetectable viral load at the latest visit was being on HAART (p < .05). Looking at those only with an undetectable viral load at the earliest visit, the only predictor of declining to a detectable viral load was number of kept appointments (p < 003), and being on HAART (p < .05).
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ABSTRACT: Retention in care is important for all HIV-infected persons and is strongly associated with initiation of antiretroviral therapy and viral suppression. However, it is unclear how retention in care and age interact to effect viral suppression. We evaluated whether the association between retention and viral suppression differed by age at entry into care. Cross-sectional analysis (2006-2010) involving 17,044 HIV-infected adults in 14 clinical cohorts across the U.S. and Canada. Patients contributed one year of data during their first full calendar year of clinical observation. Poisson regression examined associations between retention measures [U.S. National HIV/AIDS Strategy (NHAS), U.S. Department of Health and Human Services (DHHS), 6-month gap, and 3-month visit constancy] and viral suppression (HIV RNA ≤200 copies/mL) by age group: 18-29, 30-39, 40-49, 50-59, and ≥60 years old. Overall, 89% of patients were retained in care using the NHAS measure, 74% with the DHHS indicator, 85% did not have a 6-month gap, and 62% had visits in 3-4 quarters of the year; 54% achieved viral suppression. For each retention measure, the association with viral suppression was significant for only the younger age groups (18-29 and 30-39 years): 18-29 [adjusted prevalence ratio (APR)=1.33, 95% confidence interval (CI)=1.03-1.70]; 30-39 (APR=1.23, CI=1.01-1.49); 40-49 (APR=1.06, CI=0.90-1.22); 50-59 (APR=0.92, CI=0.75-1.13); ≥60 years (APR=0.99, CI=0.63-1.56) using the NHAS measure as a representative example. These results have important implications for improving viral control among younger adults, emphasizing the crucial role retention in care plays in supporting viral suppression in this population.Journal of acquired immune deficiency syndromes 12/2014; DOI:10.1097/QAI.0000000000000489
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ABSTRACT: Suboptimal engagement in HIV care increases the risk of HIV-related morbidity and mortality; however, a comprehensive and practical measure of engagement in care does not exist. The objective of our study was to identify and develop a composite of engagement in HIV care. From May to August 2013, we conducted a cross-sectional study of HIV-positive individuals who consented to participate in an online survey. Engagement in care was assessed by the following self-reported variables: (1) having attended an HIV health-care provider appointment in the past six months, (2) reporting a scheduled future HIV health-care provider appointment, (3) knowing their last CD4(+) cell count, (4) knowing their antiretroviral (ARV) medication names, (5) reporting ARV adherence ≥80% on the visual analog scale (VAS) and rating scale, (6) reporting adherence ≥90% on the VAS and rating scale, and (7) not having missed all ARVs for at least four days in a row in the past three months. To create the composite of engagement in care, the presence or absence of these variables were summed and categorized (7 = "high engagement," 5-6 = "moderate engagement," and 0-4 = "low engagement"). We examined the correlation between this composite and self-reported HIV viral load (VL; detectable versus undetectable) in a logistic regression model. We surveyed 1259 HIV-positive individuals: 85% reporting an undetectable VL and 67% reporting excellent adherence. Approximately 89%, 88%, and 67% of those with high, moderate, and low engagement, respectively, had an undetectable VL. Having moderate engagement was associated with 3.5-fold higher odds, and high engagement was associated with 4.0-fold higher odds of virologic undetectability compared to low engagement (overall p-value < 0.0001). Our data indicate that this novel and comprehensive composite of engagement may be a useful tool in clinical and research settings given its high correlation with virologic outcomes. Future research should validate this composite in other populations and examine it prospectively.AIDS Care 12/2014; 27(5):1-5. DOI:10.1080/09540121.2014.986052 · 1.60 Impact Factor
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ABSTRACT: Attendance at biannual medical encounters has been proposed as a minimum national standard for adequate engagement in HIV care. Using data from the HIV Outpatient Study (HOPS), we analyzed how well dates of HIV-related laboratory testing correlated with attendance at biannual medical encounters.JAIDS Journal of Acquired Immune Deficiency Syndromes 11/2014; DOI:10.1097/QAI.0000000000000406 · 4.39 Impact Factor