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Past Care Predicts Future Care in Out-of-Care People Living with HIV: Results of a Clinic-Based Retention-in-Care Intervention in North Carolina

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Abstract

Poor retention in care is associated with higher viral load (VL) results and decreased rates of viral load suppression (VS) in people living with HIV (PLWH). Therefore, improving retention in HIV care is a priority of national significance. The NC-LINK Retention Project utilized a systematic approach to identify, locate, and attempt to return to care patients who did not attend a clinic appointment for 6–9 months. Clinical and surveillance data were used to evaluate associations between patient characteristics and VL outcomes. Between January 1, 2013 and December 31, 2014, 1118 patients at participating clinics were identified as out-of-care and referred to retention staff. Of these, 712 (64%) were located in North Carolina. Patients with recent prior medical care (aPR 1.43, 95% CI 1.25, 1.66) and recent VS (aPR 1.28, 95% CI 1.16, 1.41) were more likely to be located. Of located patients, 58% re-engaged in care within 90 days of retention referral. Patients who achieved VS within 180 days were more likely to be 40–49 years (aPR 1.19 95% CI 1.01–1.40; compared with 18–29 age group), had insurance at their last visit (aPR 1.19 95% CI 1.01–1.77), had a care visit in the prior year (aPR 1.37 95% CI 1.05–1.77), and had VS at the prior care visit (aPR 2.54 95% CI 1.98–3.25). Clinic-based retention efforts may be effective at helping PLWH decrease out-of-care periods, but prior patterns of care usage persist.

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Funding

This research was supported by funds from HRSA’s Special Projects of National Significance Initiative: Systems Linkages (H97HA22695). The authors have no conflicts of interest to report. This study was conducted with the approval of the Institutional Review Board. The program was implemented as clinical care and did not require written consent. Written consent was obtained for focus groups and interviews. The authors also acknowledge the clinic staff, providers, and patients for their invaluable contributions to this research. The content is solely the responsibility of the authors and does not necessarily represent the official views of the Health Resources and Services Administration.

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Author notes

  1. Kristen Sullivan

    Present address: Center for Bioethics, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA

  2. Evelyn Byrd Quinlivan

    Present address: National Coalition of Independent Scholars, 103 Wild Turkey Trail, Chapel Hill, NC, 27516, USA

Authors and Affiliations

  1. NC Department of Health and Human Services, Communicable Disease Branch, Raleigh, NC, USA

    Jenna Donovan

  2. Center for Health Policy and Inequalities Research, Duke Global Health Institute, Duke University, Durham, NC, USA

    Kristen Sullivan

  3. Section on Infectious Diseases Wake Forest University School of Medicine, Winston-Salem, NC, USA

    Aimee Wilkin & Jennifer Keller

  4. East Carolina University, Greenville, NC, USA

    Nada Fadul

  5. Institute for Global Health and Infectious Diseases, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA

    Amy Heine, Anna LeViere & Evelyn Byrd Quinlivan

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  1. Jenna Donovan
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Contributions

All authors have made a contribution to the manuscript work, analysis, writing or editing and accept responsibility for publication. The authors also acknowledges the clinic staff, providers, and patients for their invaluable contributions to this research.

Corresponding author

Correspondence to Evelyn Byrd Quinlivan.

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Conflict of interest

A Wilkin receives research funding from Gilead, Janssen, Pfizer. All other authors report no real or perceived vested interests that relate to this article that could be construed as a conflict of interest.

Ethical Approval for Human Subjects

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

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This article does not contain any studies with animals performed by any of the authors.

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Donovan, J., Sullivan, K., Wilkin, A. et al. Past Care Predicts Future Care in Out-of-Care People Living with HIV: Results of a Clinic-Based Retention-in-Care Intervention in North Carolina. AIDS Behav 22, 2687–2697 (2018). https://doi.org/10.1007/s10461-018-2106-5

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  • DOI: https://doi.org/10.1007/s10461-018-2106-5

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