Abstract
ObjectiveWe sought to quantify agreement between Institute of Medicine (IOM) and Department of Health and Human Services (DHHS) retention indicators, which have not been compared in the same population, and assess clinical retention within the largest HIV cohort collaboration in the U.S.DesignObservational study from 2008–2010, using clinical cohort data in the North American AIDS Cohort Collaboration on Research and Design (NA-ACCORD).MethodsRetention definitions used HIV primary care visits. The IOM retention indicator was: ≥2 visits, ≥90 days apart, each calendar year. This was extended to a 2-year period; retention required meeting the definition in both years. The DHHS retention indicator was: ≥1 visit each semester over 2 years, each ≥60 days apart. Kappa statistics detected agreement between indicators and C statistics (areas under Receiver-Operating Characteristic curves) from logistic regression analyses summarized discrimination of the IOM indicator by the DHHS indicator.ResultsAmong 36,769 patients in 2008–2009 and 34,017 in 2009–2010, there were higher percentages of participants retained in care under the IOM indicator than the DHHS indicator (80% vs. 75% in 2008–2009; 78% vs. 72% in 2009–2010, respectively) (p<0.01), persisting across all demographic and clinical characteristics (p<0.01). There was high agreement between indicators overall (κ = 0.83 in 2008–2009; κ = 0.79 in 2009–2010, p<0.001), and C statistics revealed a very strong ability to predict retention according to the IOM indicator based on DHHS indicator status, even within characteristic strata.ConclusionsAlthough the IOM indicator consistently reported higher retention in care compared with the DHHS indicator, there was strong agreement between IOM and DHHS retention indicators in a cohort demographically similar to persons living with HIV/AIDS in the U.S. Persons with poorer retention represent subgroups of interest for retention improvement programs nationally, particularly in light of the White House Executive Order on the HIV Care Continuum.
Highlights
Retention in clinical care for HIV-infected patients is important for achieving and maintaining improved individual and public health outcomes [1,2]
Conclusions: the Institute of Medicine (IOM) indicator consistently reported higher retention in care compared with the Department of Health and Human Services (DHHS) indicator, there was strong agreement between IOM and DHHS retention indicators in a cohort demographically similar to persons living with HIV/AIDS in the U.S Persons with poorer retention represent subgroups of interest for retention improvement programs nationally, in light of the White House Executive Order on the HIV Care Continuum
We investigated whether clinical retention was associated with demographic characteristics, including age at first visit during the study period, race/ethnicity, HIV transmission risk group, sex, CD4+ lymphocyte (CD4) count, prescription of antiretroviral therapy (ART) during the study period, and suppression of plasma HIV-1 RNA
Summary
Retention in clinical care for HIV-infected patients is important for achieving and maintaining improved individual and public health outcomes [1,2]. The Institute of Medicine (IOM) and the US Department of Health and Human Services (DHHS) recently endorsed two different indicators for retention in HIV care. The IOM indicator, similar to one proposed by the Health Resources and Services Administration (HRSA) HIV/AIDS Bureau in 2009, summarizes clinical retention across a 12-month period [3]. The DHHS indicator requires a 24-month period to measure retention, which is consistent with the current HRSA guidelines (altered in 2013) [4,5]. Because of the potential for adoption of ‘‘competing’’ standards by different agencies or research groups, we undertook a comparison of the IOM and DHHS retention-incare metrics [6,7] using data from the North American AIDS Cohort Collaboration On Research and Design (NA-ACCORD)
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