Geographic Variations in Retention in Care among HIV-Infected Adults in the United States

Peter F Rebeiro, Stephen J Gange, Michael A Horberg, Alison G Abraham, Sonia Napravnik, Hasina Samji, Baligh R Yehia, Keri N Althoff, Richard D Moore, Mari M Kitahata, Timothy R Sterling, Frank C Curriero and for the North American AIDS Cohort Collaboration on Research and Design (NA-ACCORD)

PLOS ONE, 2016, vol. 11, issue 1, 1-17

Abstract: Objective: To understand geographic variations in clinical retention, a central component of the HIV care continuum and key to improving individual- and population-level HIV outcomes. Design: We evaluated retention by US region in a retrospective observational study. Methods: Adults receiving care from 2000–2010 in 12 clinical cohorts of the North American AIDS Cohort Collaboration on Research and Design (NA-ACCORD) contributed data. Individuals were assigned to Centers for Disease Control and Prevention (CDC)-defined regions by residential data (10 cohorts) and clinic location as proxy (2 cohorts). Retention was ≥2 primary HIV outpatient visits within a calendar year, >90 days apart. Trends and regional differences were analyzed using modified Poisson regression with clustering, adjusting for time in care, age, sex, race/ethnicity, and HIV risk, and stratified by baseline CD4+ count. Results: Among 78,993 adults with 444,212 person-years of follow-up, median time in care was 7 years (Interquartile Range: 4–9). Retention increased from 2000 to 2010: from 73% (5,000/6,875) to 85% (7,189/8,462) in the Northeast, 75% (1,778/2,356) to 87% (1,630/1,880) in the Midwest, 68% (8,451/12,417) to 80% (9,892/12,304) in the South, and 68% (5,147/7,520) to 72% (6,401/8,895) in the West. In adjusted analyses, retention improved over time in all regions (p

Date: 2016
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Persistent link: https://EconPapers.repec.org/RePEc:plo:pone00:0146119

DOI: 10.1371/journal.pone.0146119

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