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. 2019 Mar 7;6(4):ofz120.
doi: 10.1093/ofid/ofz120. eCollection 2019 Apr.

Compound Retention in Care and All-Cause Mortality Among Persons Living With Human Immunodeficiency Virus

Emma Sophia Kay  1 , D Scott Batey  2 , Andrew O Westfall  2 , Katerina Christopoulos  3 , Stephen R Cole  4 , Elvin H Geng  3 , W Christopher Mathews  5 , Richard D Moore  6 , Michael J Mugavero  2
Affiliations

Compound Retention in Care and All-Cause Mortality Among Persons Living With Human Immunodeficiency Virus

Emma Sophia Kay et al. Open Forum Infect Dis. .

Abstract

Background: To 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.

Methods: 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 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.

Results: Ten 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).

Conclusions: Missed 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.

Keywords: HIV/AIDS; hazard ratio; mortality hazards; retention in care.

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Figures

Figure 1.
Figure 1.
Kaplan–Meier survival curves for all-cause mortality among patients classified as retained or not retained 12 months after initiation of antiretroviral therapy according to Institute of Medicine (IOM) and missed-visits (no-show) indicators. (The IOM measure defines retention as having ≥2 kept [attended] primary care visits separated by ≥90 days during a 12-month period.) The number of patients at risk is shown above the x-axis. A, Retained defined as 0 no-shows. B, Retained defined as <3 no-shows. C, Retained defined as <2 no-shows.
See this image and copyright information in PMC

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