Beyond binary retention in HIV care: predictors of the dynamic processes of patient engagement, disengagement, and re-entry into care in a US clinical cohort

AIDS
Hana LeeCenters for AIDS Research Network of Integrated Clinical Systems (CNICS) Investigators

Abstract

Studies examining engagement in HIV care often capture cross-sectional patient status to estimate retention and identify predictors of attrition, which ignore longitudinal patient care-seeking behaviors. We describe the cyclical nature of (dis)engagement and re-entry into HIV care using the state transition framework. We represent the dynamic patterns of patient care-retention using five states: engaged in care, missed one, two, three, or more expected visits, and deceased. Then we describe various care-seeking behaviors in terms of transitioning from one state to another (e.g. from disengaged to engaged). This analysis includes 31 009 patients enrolled in the Center for AIDS Research Network of Integrated Systems (CNICS) in the United States from 1996 to 2014. Multistate models for longitudinal data were used to identify barriers to retention and subgroups at higher risk of falling out of care. The initial 2 years following primary engagement in care were a crucial time for improving retention. Patients who had not initiated antiretroviral therapy, with lower CD4 cell counts, higher viral load, or not having an AIDS-defining illness were less likely to be retained in care. Beyond the individual patient characteristics typicall...Continue Reading

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Citations

Mar 11, 2019·AIDS and Behavior·Eva A EnnsKeith Henry
Apr 15, 2020·Scientific Reports·Arthi RamachandranJessica P Ridgway
Mar 17, 2020·Clinical Infectious Diseases : an Official Publication of the Infectious Diseases Society of America·Aaloke ModyElvin H Geng
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Jul 16, 2019·HIV Research & Clinical Practice·Agnese ComelliEugenia Quiros-Roldan
Mar 22, 2019·MMWR. Morbidity and Mortality Weekly Report·Zihao LiH Irene Hall
Nov 6, 2020·Journal of the American Medical Informatics Association : JAMIA·Tomasz OliwaJessica P Ridgway
Nov 6, 2020·Journal of Acquired Immune Deficiency Syndromes : JAIDS·Laura K BeresElvin Geng
Mar 12, 2021·The Journal of Antimicrobial Chemotherapy·Lise CuzinUNKNOWN Dat’AIDS Study Group
May 6, 2021·Current HIV/AIDS Reports·Aaloke ModyElvin H Geng

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