Olatosi BA, Probst JC, Stoskopf CH, Martin AB, Duffus WA. Patterns of engagement in care by HIV-infected adults: South Carolina, 2004-2006

Tillman School of Business, Department of Healthcare Management and Organizational Development, Mount Olive College, Mount Olive, North Carolina 28365, USA.
AIDS (London, England) (Impact Factor: 5.55). 03/2009; 23(6):725-30. DOI: 10.1097/QAD.0b013e328326f546
Source: PubMed


Identify factors associated with HIV care utilization in South Carolina.
Cross-sectional analysis of South Carolina nonpregnant HIV-infected individuals (N = 13,042) for the period 1 January 2004 to 31 December 2006.
Reporting of HIV laboratory markers is legally mandated in South Carolina. Individuals with reported viral load tests or CD4 cell counts during a calendar year were defined as 'in HIV-medical care' that year. Care utilization categories were in care, care all 3 years; not-in-care (NIC), no care received; and transitional care, during some but not all years. Multinomial logistic regression using generalized logits was used to estimate relationships between care utilization and predictor variables.
Five thousand, two hundred and seventeen (40.0%) of South Carolina HIV-infected adults were NIC and 3300 (25.3%) were in transitional care during 2004-2006. Although a larger number of black than white HIV-infected adults were NIC, adjusted odds for NIC status were lower among blacks than whites [adjusted odds ratio (AOR), 0.82; 95% confidence interval 0.74, 0.92)]. Women had lower odds of being NIC than men (AOR, 0.66; 95% confidence interval 0.58, 0.74). Compared with individuals 55 years or older, individuals who were 25-34 years old were most likely to demonstrate both the NIC (AOR, 1.85; 95% confidence interval 1.29, 2.65) and transitional (AOR, 1.85; 95% confidence interval 1.31, 2.62) care patterns.
Large proportions of the South Carolina HIV-infected adult population are not consistently accessing HIV-medical care. Targeted programs are needed to improve engagement for HIV-infected adults most likely to transition or not be in care.

14 Reads
  • [Show abstract] [Hide abstract]
    ABSTRACT: This review examines situations in which information from cohort studies has proved to be useful for the development of treatment guidelines. Although there are several reasons why randomized controlled trials (RCTs) are felt to provide the most robust evidence for treatment guidelines, they may suffer from insufficient duration of follow-up, inadequate power to consider differences in important adverse events and highly selected patient populations. Furthermore, as most RCTs are performed for licensing purposes, strategic treatment decisions often lack supportive evidence from RCTs. Although data from cohort studies may be used to complement information from RCTs, cohort studies themselves are susceptible to several biases (most notably confounding) which may limit their findings. However, in the HIV field, information from such studies has been influential in guiding decisions relating to when to start highly active antiretroviral therapy, what drugs to use in the initial highly active antiretroviral therapy regimen and when to switch highly active antiretroviral therapy should virological failure occur. Given the biases that may be present, caution should be exercised when interpreting findings from cohort studies, particularly if comparisons are made of treatment strategies that involve some element of patient or clinician choice.
    No preview · Article · Dec 2009 · Current Opinion in Infectious Diseases
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Substance abuse and addiction are highly prevalent in HIV-infected individuals. Substance abuse is an important comorbidity that affects the delivery and outcomes of HIV medical management. In this paper I will review data examining the associations between substance abuse and HIV treatment and potential strategies to improve outcomes in this population that warrant further investigation. Current - but not past - substance abuse adversely affects engagement in care, acceptance of antiretroviral therapy, adherence with therapy, and long-term persistence in care. Substance abuse treatment appears to facilitate engagement in HIV care, and access to evidence-based treatment for substance abuse is central to addressing the HIV epidemic. Strategies that show promise for HIV-infected substance abusers include integrated treatment models, directly observed therapy, and incentive-based interventions.
    Preview · Article · Sep 2010 · Life sciences
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Engagement in HIV care is increasingly recognized as a crucial step in maximizing individual patient outcomes. The recently updated HIV Medicine Association primary HIV care guidelines include a new recommendation highlighting the importance of extending adherence beyond antiretroviral medications to include adherence to clinical care. Beyond individual health, emphasis on a "test and treat" approach to HIV prevention highlights the public health importance of engagement in clinical care as an essential intermediary between the putative benefits of universal HIV testing ("test") followed by ubiquitous antiretroviral treatment ("treat"). One challenge to administrators, researchers and clinicians who want to systematically evaluate HIV clinical engagement is deciding on how to measure retention in care. Measuring retention is complex as this process includes multiple clinic visits (repeated measures) occurring longitudinally over time. This article provides a synthesis of five commonly used measures of retention in HIV care, highlighting their methodological and conceptual strengths and limitations, and suggesting situations where certain measures may be preferred over others. The five measures are missed visits, appointment adherence, visit constancy, gaps in care, and the Human Resources and Services Administration HIV/AIDS Bureau (HRSA HAB) performance measure for retention in HIV care. As has been noted for antiretroviral medication adherence, there is no gold standard to measure retention in care, and consideration of the advantages and limitations of each measure, particularly in the context of the desired application, should guide selection of a retention measure.
    Preview · Article · Oct 2010 · AIDS patient care and STDs
Show more