Abstract
BackgroundTo 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.MethodsThe 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.ResultsTen 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).ConclusionsMissed 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.
Highlights
To obtain optimal health outcomes, persons living with human immunodeficiency virus (HIV) must be retained in clinical care
Patients retained by the Institute of Medicine (IOM) but not the missed-visits measure (42%) had a higher hazard ratio (HR) for mortality (1.72; 95% confidence interval (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)
Summary
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 sample consisted of 4162 ART-naive adult patients (≥18 years old) who initiated therapy between January 2000 and July 2010 at any of 5 sites associated with the Center for AIDS Research Network of Integrated Clinical Systems. All-cause mortality for patients retained by missed-visits measure only. All-cause mortality for patients retained by IOM measure only. AThe IOM measure defines retention as having ≥2 kept (attended) primary care visits separated by ≥90 days during a 12-month period
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