Compound Retention in Care and All-Cause Mortality Among Persons Living With Human Immunodeficiency Virus.

Abstract

BACKGROUND:

To obtain optimal health outcomes, persons living with human immunodeficiency virus (HIV) must be retained in clinical care. We examined the relationships between 4 possible combinations of 2 separate retention measures (missed visits and the Institute of Medicine [IOM] indicator) and all-cause mortality.

METHODS:

The sample included 4162 antiretroviral therapy (ART)-naive patients who started ART between January 2000 and July 2010 at any of 5 US sites of the Center for AIDS Research Network of Integrated Clinical Systems. The independent variable of interest was retention, captured over the 12-month period after the initiation of ART. The study outcome, all-cause mortality 1 year after ART initiation, was determined by querying the Social Security Death Index or the National Death Index. We evaluated the associations of the 4 categories of retention with all-cause mortality, using the Cox proportional hazards models.

RESULTS:

Ten percent of patients did not meet retention standards for either measure (hazard ratio [HR], 2.26; 95% confidence interval [CI], 1.59-3.21). Patients retained by the IOM but not the missed-visits measure (42%) had a higher HR for mortality (1.72; 95% CI, 1.33-2.21) than patients retained by both measures (41%). Patients retained by the missed-visits but not the IOM measure (6%) had the same mortality hazards as patients retained by both measures (HR, 1.01; 95% CI, .54-1.87).

CONCLUSIONS:

Missed visits within the first 12 months of ART initiation are a major risk factor for subsequent death. Incorporating missed visits in clinical and public health retention and viral suppression programming is advised.

• Authors: Emma Sophia Kay, D Scott Batey, Andrew O Westfall, Katerina Christopoulos, Stephen R Cole, Elvin H Geng, W Christopher Mathews, Richard D Moore, Michael J Mugavero
• Journal: Open forum infectious diseases (Open Forum Infect Dis) Vol. 6 Issue 4 Pg. ofz120 (Apr 2019) ISSN: 2328-8957 [Print] United States
• PMID: 31041339 (Publication Type: Journal Article)