English Kellee, May Sarah B, Davila Jessica A, Cully Jeffrey A, Dindo Lilian, Amico K Rivet, Kallen Michael A, Giordano Thomas P
School of Health Professions, Baylor College of Medicine, Houston, Texas, USA.
Department of Medicine, Baylor College of Medicine, Houston, Texas, USA.
Open Forum Infect Dis. 2020 May 26;7(6):ofaa193. doi: 10.1093/ofid/ofaa193. eCollection 2020 Jun.
Understanding factors influencing retention in care (RIC) and viral load improvement (VLI) in people with HIV (PWH) who are out of care and hospitalized will assist in intervention development for this vulnerable population.
The study was a post hoc analysis of prospectively collected data. Hospitalized participants were enrolled if they were newly diagnosed with HIV during the hospitalization or out of HIV care. Participants completed surveys at baseline and 6 months postenrollment and laboratory studies of viral load (VL). Outcomes were RIC (2 completed visits, 1 within 30 days of discharge) and VLI (VL <400 or at least a 1-log decrease) 6 months after discharge. Univariate and multivariate regression analyses were conducted examining the contributions of predisposing, enabling, and need factors to outcomes.
The study cohort included 417 participants enrolled between 2010 and 2013. The population was 73% male, 67% non-Hispanic black, 19% Hispanic, and 70% uninsured. Sixty-five percent had a baseline CD4 <200 cells/mm, 79% had a VL >400 copies/mL or missing, and the population was generally poor with low educational attainment. After discharge from the hospital, 60% did not meet the definition for RIC, and 49% did not have VLI. Modifiable factors associated with the outcomes include drug use (including marijuana alone and other drugs), life instability (eg, housing, employment, and life chaos), and using avoidance coping strategies in coping with HIV.
Hospitalized out-of-care PWH in the United States are at high risk of poor re-engagement in care after discharge. Interventions for this population should focus on improving socioeconomic stability and coping with HIV and reducing drug use.
了解影响失访且住院的艾滋病毒感染者（PWH）持续接受治疗（RIC）和病毒载量改善（VLI）的因素，将有助于为这一弱势群体制定干预措施。
本研究是对前瞻性收集的数据进行的事后分析。如果住院参与者在住院期间新诊断出感染艾滋病毒或失访，则将其纳入研究。参与者在基线和入组后6个月完成调查问卷，并进行病毒载量（VL）的实验室研究。结局指标为出院后6个月的持续接受治疗（2次完整就诊，其中1次在出院后30天内）和病毒载量改善（VL<400或至少下降1个对数）。进行单因素和多因素回归分析，以检验易患因素、促成因素和需求因素对结局的影响。
研究队列包括2010年至2013年期间入组的417名参与者。该人群中73%为男性，67%为非西班牙裔黑人，19%为西班牙裔，70%未参保。65%的参与者基线CD4<200细胞/mm³，79%的参与者VL>400拷贝/mL或数据缺失，且该人群普遍贫困，受教育程度低。出院后，60%的参与者未达到持续接受治疗的定义，49%的参与者未实现病毒载量改善。与结局相关的可改变因素包括药物使用（包括仅使用大麻和其他药物）、生活不稳定（如住房、就业和生活混乱）以及在应对艾滋病毒时使用回避应对策略。
在美国，失访且住院的艾滋病毒感染者出院后重新参与治疗的情况较差，风险较高。针对这一人群的干预措施应侧重于改善社会经济稳定性、应对艾滋病毒以及减少药物使用。
