Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.
Division of Infectious Diseases, Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama.
AIDS. 2022 Jul 1;36(8):1181-1189. doi: 10.1097/QAD.0000000000003232. Epub 2022 Jun 21.
To describe retention in HIV care based on various definitions of retention in the modern treatment era.
A cohort study of people enrolled in care at seven mostly urban HIV clinics across the United States, 2010-2018.
We estimated retention based on missed visits, kept visits, kept encounters (clinical visits, CD4 counts, and viral loads), and HIV labs. We contrasted risk factors for retention by different definitions and estimated odds ratios for of viral suppression and hazard ratios for mortality in 2 years immediately following the year in which retention was defined (the study year).
Across 108 171 person-years (N = 21 481 people), in 71% of years people kept ≥75% of scheduled visits; in 78%, people kept ≥2 visits >90 days apart; in 74%, people had ≥2 HIV labs >90 days apart; and in 47%, people had no gaps >6 months in clinic visits. Missing >25% of scheduled visits despite attending ≥2 visits >90 days apart was associated with nonwhite non-Hispanic race/ethnicity, history of injection drug use, and prior AIDS diagnosis. In contrast, attending ≥75% of scheduled visits while not attending ≥2 visits >90 days apart was associated with male sex, white race, no injection drug use history, and no prior AIDS diagnosis. Subsequent viral nonsuppression was more strongly associated with missed- than kept-visit measures of retention; 2-year mortality was only associated with failure to be retained by missed-visit measures.
Missed and kept-visit definitions of retention capture different constructs. Missed-visit measures are more strongly associated with poor HIV outcomes.
根据现代治疗时代保留的各种定义，描述艾滋病毒护理中的保留情况。
一项在美国七个主要城市艾滋病毒诊所接受护理的人群的队列研究，时间为 2010 年至 2018 年。
我们根据错过就诊、保留就诊、保留就诊次数（临床就诊、CD4 计数和病毒载量）和艾滋病毒检测来估计保留率。我们对比了不同定义下保留的风险因素，并估计了在定义保留的那一年之后的两年内病毒抑制的优势比和死亡率的风险比（研究年）。
在 108171 人年（N=21481 人）中，在 71%的年份中，人们保留了≥75%的预约就诊；在 78%的年份中，人们保留了≥2 次间隔>90 天的就诊；在 74%的年份中，人们有≥2 次间隔>90 天的艾滋病毒检测；在 47%的年份中，人们的就诊间隔没有超过 6 个月的空白。尽管就诊间隔>90 天的就诊次数≥2 次，但仍错过>25%的预约就诊，与非白人和非西班牙裔种族/民族、注射吸毒史和既往艾滋病诊断有关。相比之下，就诊间隔>90 天的就诊次数≥75%，而就诊间隔>90 天的就诊次数<2 次，与男性、白人、无注射吸毒史和无既往艾滋病诊断有关。随后病毒未抑制与错过就诊的保留措施更密切相关；2 年死亡率仅与错过就诊的保留措施有关。
错过就诊和保留就诊的保留定义捕捉到不同的结构。错过就诊的措施与较差的艾滋病毒结果更密切相关。
