578. Virtual vs. True: Identifying Out-of-Care HIV Patients at Lower Risk for Poor Health Outcomes

Abstract

BackgroundEngagement-in-care is a key component of the HIV care cascade. The CDC reports an engagement-in-care rate for people living with HIV (PLWH) of only 58%. Given the resource intense nature of care re-engagement efforts, it may be useful to identify sub-groups of lost-to-care (LTC) patients at lower risk for poor outcomes. We report on a group of patients whom have had no medical visit, but whom have had lab monitoring in the last year, and who may not require as intense re-engagement interventions.MethodsAt the Ruth M. Rothstein CORE Center, a large, Chicago-area, safety-net HIV clinic which cares for nearly 5,000 PLHW, between April 1, , 2017 and February 1, 2018 we identified patients who had no medical visit within the prior 12 months, but at least one visit in the prior 36 months. Such LTC patients that had no lab monitoring at outside clinics, as determined via collaboration with Chicago Department of Public Health, are included in our analysis. We defined LTC patients as either “true”, if they had no visits or lab monitoring city-wide or “virtual” if they had lab monitoring at the CORE Center, but no medical visits. We report on clinical and demographic differences for these “true” vs. “virtual” LTC patients, and perform logistic regression, assessing for correlation with whether patients subsequently returned to care.ResultsFive hundred patients met our LTC definition; 55 “virtual” and 445 “true.” “Virtual” vs. “true” LTC patients more likely had private insurance (18% vs. 9%) or coverage by the state’s ADAP program (13% vs. 2%; P < 0.001 for insurance differences); “true” vs. “virtual” LTC patients more often received Ryan White case management services (69% vs. 15%, P < 0.001). More “virtual” vs. “true” LTC patients have subsequently returned to care (47% vs. 33%, P = 0.03). Active insurance most strongly associated with subsequent return to care on logistic regression.ConclusionWe found that LTC patients whom had ongoing lab monitoring during their gap in medical visits were more likely to have private insurance or ADAP coverage, while being less likely to have received Ryan White case management services. Prospectively identifying LTC patients more likely to have favorable outcomes may free up re-engagement resources for use with higher need patients.Disclosures R. Lubelchek, Viiv: Scientific Advisor, Salary.