Clinic-Level Factors Associated with Retention in Care among People Living with HIV in a Multi-Site United States Cohort, 2010-2016.

Abstract

BACKGROUND\nRetention in care (RIC) leads to reduced HIV transmission and mortality. Few studies have investigated the availability of clinic services and RIC among people living with HIV (PLWH) in the United States (US). We conducted a multi-site retrospective cohort study to identify clinic services associated with RIC from 2010-2016 in the US.\n\n\nMETHODS\nPLWH with ≥1 attended HIV primary care visit from 2010-2016 at seven sites in the Centers for AIDS Research Network of Integrated Clinical Systems (CNICS) were included. Clinic-level factors evaluated via site survey included patients per provider/trainee, peer navigation, RIC posters/brochures, laboratory test timing, flexible scheduling, appointment reminder methods, and stigma support services. RIC was defined as ≥2 encounters per year, ≥90 days apart, observed until death, administrative censoring (December 31, 2016), or loss to follow-up (censoring at first 12-month interval without a visit if there were no future visits). Poisson regression with robust error variance, clustered by site and adjusted for calendar year, age, sex, race/ethnicity, and HIV transmission risk factor, estimated risk ratios (RR) and 95% confidence intervals (CI) for RIC.\n\n\nRESULTS\nAmong 21,046 PLWH contributing 103,348 person-years, 67% of person-years were retained. Availability of text appointment reminders (RR:1.13; 95% CI:1.03-1.24) and stigma support services (RR:1.11; 95% CI:1.04-1.19) were associated with better RIC. Disparities persisted with respect to age, sex, and race after accounting for clinic-level factors.\n\n\nCONCLUSION\nAvailability of text appointment reminders and stigma support services was associated with higher rates of RIC indicating that these may be feasible and effective approaches for improving RIC.