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Published in: AIDS and Behavior 3/2014

01-03-2014 | Original Paper

Impact of Non-HIV Related Comorbidities on Retention in HIV Medical Care: Does Retention Improve Over Time?

Authors: Timothy N. Crawford, Wayne T. Sanderson, Patrick Breheny, Steven T. Fleming, Alice Thornton

Published in: AIDS and Behavior | Issue 3/2014

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Abstract

The purpose of this study was to understand how the presence of comorbid conditions affects retention in HIV medical care over time. A retrospective cohort design employing a medical chart review was conducted. A generalized linear mixed model was used to determine the predictors that affect retention over time. The mean follow-up for the study population was 5.75 years, and only 48.6 % achieved optimal retention. During the study period, 882 non-HIV related comorbidities were diagnosed in 610 (44.9 %) patients of whom, approximately 31 % had ≥2 comorbidities diagnosed. In the mixed model, the number of comorbidities diagnosed during the study period was associated with improved retention over time (odds ratio = 2.28; 95 % confidence interval = 1.83–2.71). Having a non-HIV related comorbid condition was associated with improved retention, while those patients who were ‘healthier’ had worse retention. More research is needed to identify factors that improve retention and to quantify the impact of these factors.
Literature
1.
go back to reference Gardner EM, McLees MP, Steiner JF, Del Rio C, Burman WJ. The spectrum of engagement in HIV care and its relevance to test-and-treat strategies for prevention of HIV infection. Clin Infect Dis. 2011;52(6):793–800.PubMedCentralPubMedCrossRef Gardner EM, McLees MP, Steiner JF, Del Rio C, Burman WJ. The spectrum of engagement in HIV care and its relevance to test-and-treat strategies for prevention of HIV infection. Clin Infect Dis. 2011;52(6):793–800.PubMedCentralPubMedCrossRef
2.
go back to reference Marks G, Gardner LI, Craw J, Crepaz N. Entry and retention in medical care among HIV-diagnosed persons: a meta-analysis. Aids. 2010;24(17):2665–78.PubMedCrossRef Marks G, Gardner LI, Craw J, Crepaz N. Entry and retention in medical care among HIV-diagnosed persons: a meta-analysis. Aids. 2010;24(17):2665–78.PubMedCrossRef
3.
go back to reference Centers for Disease Control and Prevention. Vital signs: HIV prevention through care and treatment—United States. MMWR Morb Mortal Wkly Rep. 2011;60(47):1618–23. Centers for Disease Control and Prevention. Vital signs: HIV prevention through care and treatment—United States. MMWR Morb Mortal Wkly Rep. 2011;60(47):1618–23.
5.
go back to reference Giordano TP. Retention in HIV care: what the clinician needs to know. Top Antivir Med. 2011;19(1):12–6.PubMed Giordano TP. Retention in HIV care: what the clinician needs to know. Top Antivir Med. 2011;19(1):12–6.PubMed
6.
go back to reference Giordano TP, White AC Jr, Sajja P, Graviss EA, Arduino RC, Adu-Oppong A, et al. Factors associated with the use of highly active antiretroviral therapy in patients newly entering care in an urban clinic. J Acquir Immune Defic Syndr. 2003;32(4):399–405.PubMedCrossRef Giordano TP, White AC Jr, Sajja P, Graviss EA, Arduino RC, Adu-Oppong A, et al. Factors associated with the use of highly active antiretroviral therapy in patients newly entering care in an urban clinic. J Acquir Immune Defic Syndr. 2003;32(4):399–405.PubMedCrossRef
7.
go back to reference Mugavero MJ, Davila JA, Nevin CR, Giordano TP. From access to engagement: measuring retention in outpatient HIV clinical care. AIDS Patient Care STDS. 2010;24(10):607–13.PubMedCentralPubMedCrossRef Mugavero MJ, Davila JA, Nevin CR, Giordano TP. From access to engagement: measuring retention in outpatient HIV clinical care. AIDS Patient Care STDS. 2010;24(10):607–13.PubMedCentralPubMedCrossRef
8.
go back to reference Kunutsor S, Walley J, Katabira E, Muchuro S, Balidawa H, Namagala E, et al. Clinic attendance for medication refills and medication adherence amongst an antiretroviral treatment cohort in Uganda: a prospective study. AIDS Res Treat. 2010;2010:872396.PubMedCentralPubMed Kunutsor S, Walley J, Katabira E, Muchuro S, Balidawa H, Namagala E, et al. Clinic attendance for medication refills and medication adherence amongst an antiretroviral treatment cohort in Uganda: a prospective study. AIDS Res Treat. 2010;2010:872396.PubMedCentralPubMed
9.
go back to reference Mugavero MJ, Amico KR, Westfall AO, Crane HM, Zinski A, Willig JH, et al. Early retention in HIV care and viral load suppression: implications for a test and treat approach to HIV prevention. J Acquir Immune Defic Syndr. 2012;59(1):86–93.PubMedCentralPubMedCrossRef Mugavero MJ, Amico KR, Westfall AO, Crane HM, Zinski A, Willig JH, et al. Early retention in HIV care and viral load suppression: implications for a test and treat approach to HIV prevention. J Acquir Immune Defic Syndr. 2012;59(1):86–93.PubMedCentralPubMedCrossRef
10.
go back to reference Giordano TP, Gifford AL, White AC Jr, Suarez-Almazor ME, Rabeneck L, Hartman C, et al. Retention in care: a challenge to survival with HIV infection. Clin Infect Dis. 2007;44(11):1493–9.PubMedCrossRef Giordano TP, Gifford AL, White AC Jr, Suarez-Almazor ME, Rabeneck L, Hartman C, et al. Retention in care: a challenge to survival with HIV infection. Clin Infect Dis. 2007;44(11):1493–9.PubMedCrossRef
11.
go back to reference Mugavero MJ, Lin HY, Allison JJ, Giordano TP, Willig JH, Raper JL, et al. Racial disparities in HIV virologic failure: do missed visits matter? J Acquir Immune Defic Syndr. 2009;50(1):100–8.PubMedCentralPubMedCrossRef Mugavero MJ, Lin HY, Allison JJ, Giordano TP, Willig JH, Raper JL, et al. Racial disparities in HIV virologic failure: do missed visits matter? J Acquir Immune Defic Syndr. 2009;50(1):100–8.PubMedCentralPubMedCrossRef
12.
go back to reference Rastegar DA, Fingerhood MI, Jasinski DR. Highly active antiretroviral therapy outcomes in a primary care clinic. AIDS Care. 2003;15(2):231–7.PubMedCrossRef Rastegar DA, Fingerhood MI, Jasinski DR. Highly active antiretroviral therapy outcomes in a primary care clinic. AIDS Care. 2003;15(2):231–7.PubMedCrossRef
13.
go back to reference Lucas GM, Chaisson RE, Moore RD. Highly active antiretroviral therapy in a large urban clinic: risk factors for virologic failure and adverse drug reactions. Ann Intern Med. 1999;131(2):81–7.PubMedCrossRef Lucas GM, Chaisson RE, Moore RD. Highly active antiretroviral therapy in a large urban clinic: risk factors for virologic failure and adverse drug reactions. Ann Intern Med. 1999;131(2):81–7.PubMedCrossRef
14.
go back to reference Tripathi A, Youmans E, Gibson JJ, Duffus WA. The impact of retention in early HIV medical care on viro-immunological parameters and survival: a statewide study. AIDS Res Hum Retroviruses. 2011;27(7):751–8.PubMedCrossRef Tripathi A, Youmans E, Gibson JJ, Duffus WA. The impact of retention in early HIV medical care on viro-immunological parameters and survival: a statewide study. AIDS Res Hum Retroviruses. 2011;27(7):751–8.PubMedCrossRef
15.
go back to reference Aberg JA, Kaplan JE, Libman H, Emmanuel P, Anderson JR, Stone VE, et al. Primary care guidelines for the management of persons infected with human immunodeficiency virus: 2009 update by the HIV medicine association of the infectious diseases society of America. Clin Infect Dis. 2009;49(5):651–81.PubMedCrossRef Aberg JA, Kaplan JE, Libman H, Emmanuel P, Anderson JR, Stone VE, et al. Primary care guidelines for the management of persons infected with human immunodeficiency virus: 2009 update by the HIV medicine association of the infectious diseases society of America. Clin Infect Dis. 2009;49(5):651–81.PubMedCrossRef
16.
go back to reference Giordano TP, Hartman C, Gifford AL, Backus LI, Morgan RO. Predictors of retention in HIV care among a national cohort of US veterans. HIV Clin Trials. 2009;10(5):299–305.PubMedCrossRef Giordano TP, Hartman C, Gifford AL, Backus LI, Morgan RO. Predictors of retention in HIV care among a national cohort of US veterans. HIV Clin Trials. 2009;10(5):299–305.PubMedCrossRef
17.
go back to reference Calsyn RJ, Klinkenberg WD, Morse GA, Miller J, Cruthis R, HIV/AIDS Treatment Adherence, Health Outcomes and Cost Study Group. Recruitment, engagement, and retention of people living with HIV and co-occurring mental health and substance use disorders. AIDS Care. 2004;16(Suppl 1):S56–70.PubMedCrossRef Calsyn RJ, Klinkenberg WD, Morse GA, Miller J, Cruthis R, HIV/AIDS Treatment Adherence, Health Outcomes and Cost Study Group. Recruitment, engagement, and retention of people living with HIV and co-occurring mental health and substance use disorders. AIDS Care. 2004;16(Suppl 1):S56–70.PubMedCrossRef
18.
go back to reference Joyce GF, Chan KS, Orlando M, Burnam MA. Mental health status and use of general medical services for persons with human immunodeficiency virus. Med Care. 2005;43(8):834–9.PubMedCrossRef Joyce GF, Chan KS, Orlando M, Burnam MA. Mental health status and use of general medical services for persons with human immunodeficiency virus. Med Care. 2005;43(8):834–9.PubMedCrossRef
19.
go back to reference Sullivan G, Kanouse D, Young AS, Han X, Perlman J, Koegel P. Co-location of health care for adults with serious mental illness and HIV infection. Community Ment Health J. 2006;42(4):345–61.PubMedCrossRef Sullivan G, Kanouse D, Young AS, Han X, Perlman J, Koegel P. Co-location of health care for adults with serious mental illness and HIV infection. Community Ment Health J. 2006;42(4):345–61.PubMedCrossRef
20.
go back to reference Braithwaite RS, Justice AC, Chang CC, Fusco JS, Raffanti SR, Wong JB, et al. Estimating the proportion of patients infected with HIV who will die of comorbid diseases. Am J Med. 2005;118(8):890–8.PubMedCrossRef Braithwaite RS, Justice AC, Chang CC, Fusco JS, Raffanti SR, Wong JB, et al. Estimating the proportion of patients infected with HIV who will die of comorbid diseases. Am J Med. 2005;118(8):890–8.PubMedCrossRef
21.
go back to reference Klinkenberg WD, Sacks S, HIV/AIDS Treatment Adherence, Health Outcomes and Cost Study Group. Mental disorders and drug abuse in persons living with HIV/AIDS. AIDS Care. 2004;16(Suppl 1):S22–42.PubMedCrossRef Klinkenberg WD, Sacks S, HIV/AIDS Treatment Adherence, Health Outcomes and Cost Study Group. Mental disorders and drug abuse in persons living with HIV/AIDS. AIDS Care. 2004;16(Suppl 1):S22–42.PubMedCrossRef
22.
go back to reference Anonymous. 1993 revised classification system for HIV infection and expanded surveillance case definition for AIDS among adolescents and adults. MMWR Recomm Rep. 1992;41(RR–17):1–19. Anonymous. 1993 revised classification system for HIV infection and expanded surveillance case definition for AIDS among adolescents and adults. MMWR Recomm Rep. 1992;41(RR–17):1–19.
23.
go back to reference Agresti A. Categorical data analysis. 2nd ed. New York: Wiley; 2002. p. xv, 710.CrossRef Agresti A. Categorical data analysis. 2nd ed. New York: Wiley; 2002. p. xv, 710.CrossRef
24.
go back to reference Brown H, Prescott R. Applied mixed models in medicine. Chichester: Wiley; 1999. p. xx, 408. Brown H, Prescott R. Applied mixed models in medicine. Chichester: Wiley; 1999. p. xx, 408.
25.
go back to reference Fleming ST, Schoenberg NE, Tarasenko YN, Pearce KA. Prevalence of colorectal cancer screening among a multimorbid rural Appalachian population. South Med J. 2011;104(12):811–8.PubMedCentralPubMedCrossRef Fleming ST, Schoenberg NE, Tarasenko YN, Pearce KA. Prevalence of colorectal cancer screening among a multimorbid rural Appalachian population. South Med J. 2011;104(12):811–8.PubMedCentralPubMedCrossRef
26.
go back to reference Kissinger P, Cohen D, Brandon W, Rice J, Morse A, Clark R. Compliance with public sector HIV medical care. J Natl Med Assoc. 1995;87(1):19–24.PubMedCentralPubMed Kissinger P, Cohen D, Brandon W, Rice J, Morse A, Clark R. Compliance with public sector HIV medical care. J Natl Med Assoc. 1995;87(1):19–24.PubMedCentralPubMed
27.
go back to reference Gardner LI, Marks G, Craw JA, Wilson TE, Drainoni ML, Moore RD, et al. A low-effort, clinic-wide intervention improves attendance for HIV primary care. Clin Infect Dis. 2012;55(8):1124–34.PubMedCentralPubMedCrossRef Gardner LI, Marks G, Craw JA, Wilson TE, Drainoni ML, Moore RD, et al. A low-effort, clinic-wide intervention improves attendance for HIV primary care. Clin Infect Dis. 2012;55(8):1124–34.PubMedCentralPubMedCrossRef
28.
go back to reference Sitapati AM, Limneos J, Bonet-Vazquez M, Mar-Tang M, Qin H, Mathews WC. Retention: building a patient-centered medical home in HIV primary care through PUFF (patients unable to follow-up found). J Health Care Poor Underserved. 2012;23(3 Suppl):81–95.PubMedCrossRef Sitapati AM, Limneos J, Bonet-Vazquez M, Mar-Tang M, Qin H, Mathews WC. Retention: building a patient-centered medical home in HIV primary care through PUFF (patients unable to follow-up found). J Health Care Poor Underserved. 2012;23(3 Suppl):81–95.PubMedCrossRef
29.
go back to reference Horstmann E, Brown J, Islam F, Buck J, Agins BD. Retaining HIV-infected patients in care: where are we? Where do we go from here? Clin Infect Dis. 2010;50(5):752–61.PubMed Horstmann E, Brown J, Islam F, Buck J, Agins BD. Retaining HIV-infected patients in care: where are we? Where do we go from here? Clin Infect Dis. 2010;50(5):752–61.PubMed
Metadata
Title
Impact of Non-HIV Related Comorbidities on Retention in HIV Medical Care: Does Retention Improve Over Time?
Authors
Timothy N. Crawford
Wayne T. Sanderson
Patrick Breheny
Steven T. Fleming
Alice Thornton
Publication date
01-03-2014
Publisher
Springer US
Published in
AIDS and Behavior / Issue 3/2014
Print ISSN: 1090-7165
Electronic ISSN: 1573-3254
DOI
https://doi.org/10.1007/s10461-013-0524-y

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