Patterns of retention in clinical care among HIV‐positive men in the UK CHIC Study

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We examined disparities in engagement and retention‐in‐care among men in the UK Collaborative HIV Cohort (CHIC) Study according to ethnic group and mode of HIV infection. All male subjects in UK CHIC from 1996–2011 were included. We considered factors associated with both initial engagement (follow‐up>1 day) and consistent retention in care (no interval between consecutive CD4/viral load (VL) measures>6 months). Logistic regression was used to identify associations with ethnic group and mode of HIV infection after adjusting for covariates at study entry (age, year, use of antiretrovirals (ART), AIDS). Analyses of retention also adjusted for VL/CD4 at entry and clinic. The 33210 men had a median (interquartile range) age of 36 (30,42) years at study entry, ethnic group was white (21851, 65.8%), black African (4374, 13.2%), black other (1539, 4.6%), Asian (967, 2.9%), other (2337, 7.0%) and unknown (2142, 6.5%). Mode of infection was sex between men (MSM) (22260, 67.0%), heterosexual sex (HET) (6286, 18.9%), other (1556, 4.7%) and unknown (3108, 9.4%). 32045 (96.5%) men were initially engaged in care, with no major differences by ethnic group after adjustment. Compared to MSM, initial engagement was less likely in those with heterosexual (adjusted odds ratio 0.77 [95% confidence interval 0.63–0.95]) or other (0.43 [0.33–0.56]) modes of infection. Other factors associated with initial engagement were older age, receipt of ART and having AIDS at entry; those entering UK CHIC in 2008–2011 were less likely to engage due to the shorter follow‐up time. Of the men initially engaged in care, 12644 (44.0%) were consistently retained with no interval between consecutive CD4/VL>6 months. Consistent retention was more likely in MSM than in those with other modes of infection (HET: 0.76 [0.68–0.84]; other 0.54 [0.46–0.62]). Ethnic group again did not impact greatly on subsequent retention. Other independent predictors of retention were older age, receipt of ART and AIDS at entry. Those entering UK CHIC in later years were more likely to exhibit consistent retention as were those with higher VL and lower CD4 at entry. Our study demonstrates high rates of initial engagement in care. Those infected with HIV through heterosexual sex and younger men are less likely to engage in care and, once engaged, are less likely to attend consistently. The reasons behind these differences need to be explored further to ensure equitable health care delivery.