scholarly journals Travel time to Clinic but not Neighborhood Crime Rate is associated with Retention in Care among HIV-positive Patients

2017 ◽  
Vol 4 (suppl_1) ◽  
pp. S421-S421
Author(s):  
Jessica P Ridgway ◽  
Ellen Almirol ◽  
Jessica Schmitt ◽  
Todd Schuble ◽  
John Schneider
Keyword(s):  
Travel Time ◽  
Public Transportation ◽  
Crime Rate ◽  
Viral Suppression ◽  
Retention In Care ◽  
Travel Distance ◽  
Hiv Care ◽  
People Living With Hiv ◽  
Neighborhood Crime ◽  
Retention In Hiv Care

Abstract Background Retention in HIV care can be impacted by structural factors such as crime, poverty, and clinic accessibility. We aimed to determine whether crime rate, travel time, or travel distance to clinic were associated with retention in care or viral suppression (VS) among people living with HIV (PLWH) at the largest provider of HIV care on the South Side of Chicago. Methods Using publicly available data in the Chicago Open Data Portal, we geocoded patient home addresses and clinic location. We measured distance from patient home to clinic, and travel time from patient home to clinic using car and Chicago Transit Authority (CTA) public transportation. We further measured crime rate within a two block radius of the public transportation route to clinic. Retention was defined as >2 visits, 90 days apart within 12 months, and patients were classified into 3 groups: continuously retained (CR), intermittently retained (IR), or lost to follow-up (LTFU), i.e., no visit in the last 12-months. Kruskal–Wallis rank-sum with Dunns pairwise test was used to determine whether travel time, travel distance, and crime rate were associated with retention or viral suppression. Results 780 patients were included in the study. Of these 273 (35%) were CR, 392 (50%) were IR, and 115 (15%) were LTFU. Figure 1 shows maps with geocoded data. Median distance from clinic was 3.6 [2.1–5.6] miles among those CR, 3.9 [2.5–6.0] miles among the IR, and 3.9 [2.6–6.2] miles among those LTFU. Median travel time by CTA was 37.2 [31.8–53.0] mins for CR, 42.9 [33–53] mins for IR, and 42.9 [33–59.1] mins for LTFU; by car was 15.9 [9.6–33] mins for CR, 17.1 [11.8–24.6] mins for IR, and 17.5 [12.2–24.1] mins for LTFU. Crime rate was similar across all retention groups. Though no associations were statistically significant at P < 0.05, there was a trend toward shorter distance (P = 0.07) and shorter car travel time (P = 0.06) among CR vs. IR. There was also a trend toward lower neighborhood crime rates among those VS vs. those not VS (P = 0.07). Conclusion Retention in care was not impacted by residing in high crime neighborhoods in Chicago. PLWHA who lived farther from HIV clinic and had longer travel time showed a trend toward being more likely to be IR in care vs. CR, but there was no such association for VS. Travel time may impact patient likelihood to attend HIV care appointments, but not necessarily adherence to ART. Disclosures J. P. Ridgway, Gilead FOCUS: Grant Investigator, Grant recipient

scholarly journals Predictors of Linkage to and Retention in HIV Care Following Release from Connecticut Jails and Prisons

2017 ◽  
Vol 4 (suppl_1) ◽  
pp. S38-S38
Author(s):  
Kelsey B Loeliger ◽  
Frederick L Altice ◽  
Mayur M Desai ◽  
Maria M Ciarleglio ◽  
Colleen Gallagher ◽  
...  
Keyword(s):  
Case Management ◽  
Viral Suppression ◽  
Linkage To Care ◽  
Retention In Care ◽  
Hiv Treatment ◽  
Hiv Care ◽  
People Living With Hiv ◽  
Hiv Surveillance ◽  
Targeted Interventions ◽  
Retention In Hiv Care

Abstract Background One in six people living with HIV (PLH) in the USA transition through prison or jail annually. During incarceration, people may engage in HIV care, but transition to the community remains challenging. Linkage to care (LTC) post-release and retention in care (RIC) are necessary to optimizing HIV outcomes, but have been incompletely assessed in prior observational studies. Methods We created a retrospective cohort of all PLH released from a Connecticut jail or prison (2007–2014) by linking Department of Correction demographic, pharmacy, and custody databases with Department of Public Health HIV surveillance monitoring and case management data. We assessed time to LTC, defined as time from release to first community HIV-1 RNA test, and viral suppression status at time of linkage. We used generalized estimating equations to identify correlates of LTC within 14 or 30 days after release. We also described RIC over three years following an initial release, comparing recidivists to non-recidivists. Results Among 3,302 incarceration periods from 1,350 unique PLH, 21% and 34% had LTC within 14 and 30 days, respectively, of which >25% had detectable viremia at time of linkage. Independent correlates of LTC at 14 days included incarceration periods >30 days (adjusted odds ratio [AOR] = 1.6; P < 0.001), higher medical comorbidity (AOR = 1.8; P < 0.001), antiretrovirals prescribed before release (AOR = 1.5; P = 0.001), transitional case management (AOR = 1.5; P < 0.001), re-incarceration (AOR = 0.7; P = 0.002) and conditional release (AOR = 0.6; P < 0.001). The 30-day model additionally included psychiatric comorbidity (AOR = 1.3; P = 0.016) and release on bond (AOR = 0.7; P = 0.033). Among 1,094 PLH eligible for 3-year follow-up, RIC after release declined over 1 year (67%), 2 years (51%) and 3 years (42%). Recidivists were more likely than nonrecidivists to have RIC but, among those retained, were less likely to be virally suppressed (Figure 1). Conclusion For incarcerated PLH, both LTC and RIC as well as viral suppression are suboptimal after release. PLH who receive case management are more likely to have timely LTC. Targeted interventions and integrated programming aligning health and criminal justice goals may improve post-release HIV treatment outcomes. Disclosures All authors: No reported disclosures.

scholarly journals 1322. A Mobile Technology-Based Intervention Improves HIV Care Continuum for Young People Living with HIV

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S478-S478
Author(s):  
Ping Du ◽  
John Zurlo ◽  
Tarek Eshak ◽  
Tonya Crook ◽  
Cynthia Whitener
Keyword(s):  
Mobile Technology ◽  
Viral Suppression ◽  
Retention In Care ◽  
Hiv Care ◽  
People Living With Hiv ◽  
Hiv Care Continuum ◽  
Care Continuum ◽  
Hiv Viral Suppression ◽  
Study Participants ◽  
Living With Hiv

Abstract Background Young people living with HIV (YPLWH) have lower rates of retention in care and HIV viral suppression. Multiple barriers exist to engage YPLWH in care. As nearly all YPLWH use their mobile phones to access health information and to communicate with other people, we implemented a mobile technology-based intervention with the goal to improve HIV care continuum in YPLWH. Methods YPLWH were eligible for this study if they were: (1) aged 18–34 years; (2) newly diagnosed with HIV; (3) having a history of being out of care; or (4) not virally suppressed. We recruited YPLWH during January 2017-May 2018 and followed them every 6 months. We developed a HIPAA-compliant mobile application, “OPT-In For Life,” and let participants use this app to manage their HIV care. The app integrated multiple features that enabled users to communicate with the HIV treatment team via a secure messaging function, to access laboratory results and HIV prevention resources, and to set up appointment or medication reminders. We obtained participants’ demographics, app-usage data, and medical records to evaluate if this mobile technology-based intervention would improve HIV care continuum among YPLWH. We used a quasi-experiment study design to compare the rates of retention in care and HIV viral suppression every 6 months between study participants and YPLWH who were eligible but not enrolled in the study. Results 92 YPLWH participated in this study (70% male, 56% Hispanics or Blacks, 54% retained in care, and 66% virally suppressed at baseline). On average study participants used the app 1–2 times/week to discuss various health issues and supportive services with HIV providers, to access HIV-related health information, and to manage their HIV care. At the 6-month evaluation, compared with 88 eligible YPLWH who were not enrolled in this intervention, study participants had increased rates of retention in care (baseline-to-6-month between participants and nonparticipants: 54%–84% vs. 26%–25%) and HIV viral suppression (66%–80% vs. 56%–60%). Conclusion Our study demonstrates using a HIPAA-compliant mobile app as an effective intervention to engage YPLWH in care. This intervention can be adapted by other HIV programs to improve HIV care continuum for YPLWH or broader HIV populations. Disclosures All authors: No reported disclosures.

scholarly journals Individual and neighborhood predictors of retention in care and viral suppression among Florida youth (aged 13–24) living with HIV in 2015

2019 ◽  
Vol 30 (11) ◽  
pp. 1095-1104
Author(s):  
Merhawi T Gebrezgi ◽  
Diana M Sheehan ◽  
Daniel E Mauck ◽  
Kristopher P Fennie ◽  
Gladys E Ibanez ◽  
...  
Keyword(s):  
Viral Suppression ◽  
Age Groups ◽  
Retention In Care ◽  
Population Based ◽  
Hiv Care ◽  
Foreign Born ◽  
Perinatal Hiv ◽  
Retention In Hiv Care ◽  
Older Youth ◽  
Sex With Men

Youth aged 13‒24 are less likely to be retained in HIV care and be virally suppressed than older age groups. This study aimed to assess predictors of retention in HIV care and viral suppression among a population-based cohort of youth (N = 2872) diagnosed with HIV between 1993 and 2014 in Florida. We used generalized estimating equations to estimate prevalence ratios (PRs). Retention in care was defined as evidence of engagement in care (at least one laboratory test, physician visit, or antiretroviral therapy prescription refill), two or more times, at least three months apart during 2015. Viral suppression was defined as having evidence of a viral load <200 copies/ml among those in care during 2015. Among the 2872 youth, 65.4% were retained in care, and among those in care, 65.0% were virally suppressed. Older youth (18‒24 years old) and non-Hispanic Blacks (NHBs) were less likely to be retained in care, whereas those men who have sex with men, perinatal HIV transmission, living in low socioeconomic neighborhoods, and those diagnosed with AIDS before 2016 were more likely to be retained in care. Those diagnosed with AIDS before 2016 and NHBs were less likely to be virally suppressed, whereas those men who have sex with men and foreign-born persons were more likely to be virally suppressed. Results suggest the need for targeted retention and viral suppression interventions for NHB youth and older youth (18‒24 years-age).

scholarly journals Association Between Depression and HIV Care Engagement Outcomes Among Patients Newly Initiating ART in Lilongwe, Malawi

2020 ◽  
Author(s):  
Melissa A. Stockton ◽  
Bradley N. Gaynes ◽  
Mina C. Hosseinipour ◽  
Audrey E. Pettifor ◽  
Joanna Maselko ◽  
...  
Keyword(s):  
Viral Suppression ◽  
Hiv Care ◽  
People Living With Hiv ◽  
Load Testing ◽  
Art Initiation ◽  
Retention In Hiv Care ◽  
Hiv Care Engagement ◽  
Care Outcomes ◽  
Sub Saharan ◽  
Living With Hiv

Abstract As in other sub-Saharan countries, the burden of depression is high among people living with HIV in Malawi. However, the association between depression at ART initiation and two critical outcomes—retention in HIV care and viral suppression—is not well understood. Prior to the launch of an integrated depression treatment program, adult patients were screened for depression at ART initiation at two clinics in Lilongwe, Malawi. We compared retention in HIV care and viral suppression at 6 months between patients with and without depression at ART initiation using tabular comparison and regression models. The prevalence of depression among this population of adults newly initiating ART was 27%. Those with depression had similar HIV care outcomes at 6 months to those without depression. Retention metrics were generally poor for those with and without depression. However, among those completing viral load testing, nearly all achieved viral suppression. Depression at ART initiation was not associated with either retention or viral suppression. Further investigation of the relationship between depression and HIV is needed to understand the ways depression impacts the different aspects of HIV care engagement.

scholarly journals Travel Time to Clinic but not Neighborhood Crime Rate is Associated with Retention in Care Among HIV-Positive Patients

2018 ◽  
Vol 22 (9) ◽  
pp. 3003-3008 ◽  
Author(s):  
Jessica P. Ridgway ◽  
Ellen A. Almirol ◽  
Jessica Schmitt ◽  
Todd Schuble ◽  
John A. Schneider
Keyword(s):  
Travel Time ◽  
Crime Rate ◽  
Retention In Care ◽  
Hiv Positive ◽  
Neighborhood Crime

scholarly journals Why do patients interrupt and return to antiretroviral therapy? Retention in HIV care from the patient’s perspective in Johannesburg, South Africa

PLoS ONE ◽  
2021 ◽  
Vol 16 (9) ◽  
pp. e0256540
Author(s):  
Melanie A. Bisnauth ◽  
Natasha Davies ◽  
Sibongile Monareng ◽  
Fezile Buthelezi ◽  
Helen Struthers ◽  
...  
Keyword(s):  
South Africa ◽  
Antiretroviral Therapy ◽  
Health Services ◽  
Healthcare Providers ◽  
Retention In Care ◽  
Hiv Care ◽  
People Living With Hiv ◽  
Structured Interviews ◽  
Related Factors ◽  
Retention In Hiv Care

Background Retention in care is required for optimal clinical outcomes in people living with HIV (PLHIV). Although most PLHIV in South Africa know their HIV status, only 70% are on antiretroviral therapy (ART). Improved retention in care is needed to get closer to sustained ART for all. In January 2019, Anova Health Institute conducted a campaign to encourage patients who had interrupted ART to return to care. Methods Data collection was conducted in one region of Johannesburg. This mixed methods study consisted of two components: 1) healthcare providers entered data into a structured tool for all patients re-initiating ART at nine clinics over a nine-month period, 2) Semi-structured interviews were conducted with a sub-set of patients. Responses to the tool were analysed descriptively, we report frequencies, and percentages. A thematic approach was used to analyse participant experiences in-depth. Results 562 people re-initiated ART, 66% were women, 75% were 25–49 years old. The three most common reasons for disengagement from care were mobility (30%), ART related factors (15%), and time limitations due to work (10%). Reasons for returning included it becoming easier to attend the clinic (34%) and worry about not being on ART (19%). Mobile interview participants often forgot their medical files and expressed that managing their ART was difficult because they often needed a transfer letter to gain access to ART at another facility. On the other hand, clinics that had flexible and extended hours facilitated retention in care. Conclusion In both the quantitative data, and the qualitative analysis, changing life circumstances was the most prominent reason for disengagement from care. Health services were not perceived to be responsive to life changes or mobility, leading to disengagement. More client-centred and responsive health services should improve retention on ART.

scholarly journals Development of PositiveLinks: A Mobile Phone App to Promote Linkage and Retention in Care for People With HIV (Preprint)

2018 ◽  
Author(s):  
Colleen Laurence ◽  
Erin Wispelwey ◽  
Tabor E Flickinger ◽  
Marika Grabowski ◽  
Ava Lena Waldman ◽  
...  
Keyword(s):  
Mobile Phone ◽  
Retention In Care ◽  
Hiv Care ◽  
Just In Time ◽  
People Living With Hiv ◽  
Message Board ◽  
Retention In Hiv Care ◽  
High Participation ◽  
Living With Hiv ◽  
Usability Feedback

BACKGROUND Linkage to and retention in HIV care are challenging, especially in the Southeastern United States. The rise in mobile phone app use and the potential for an app to deliver just in time messaging provides a new opportunity to improve linkage and retention among people living with HIV (PLWH). OBJECTIVE This study aimed to develop an app to engage, link, and retain people in care. We evaluated the acceptability, feasibility, and impact of the app among users. METHODS App development was informed by principles of chronic disease self-management and formative interviews with PLWH. Once developed, the app was distributed among participants, and usability feedback was incorporated in subsequent iterations. We interviewed app users after 3 weeks to identify usability issues, need for training on the phone or app, and to assess acceptability. We tracked and analyzed usage of app features for the cohort over 2 years. RESULTS A total of 77 participants used the app during the pilot study. The query response rate for the first 2 years was 47.7%. Query response declined at a rate of 0.67% per month. The community message board was the most popular feature, and 77.9% (60/77) of users posted on the board at least once during the 2 years. CONCLUSIONS The PositiveLinks app was feasible and acceptable among nonurban PLWH. High participation on the community message board suggests that social support from peers is important for people recently diagnosed with or returning to care for HIV.

scholarly journals HIV Care Continuum among Postpartum Women Living with HIV in Atlanta

2019 ◽  
Vol 2019 ◽  
pp. 1-9 ◽  
Author(s):  
Christina M. Meade ◽  
Martina Badell ◽  
Stephanie Hackett ◽  
C. Christina Mehta ◽  
Lisa B. Haddad ◽  
...  
Keyword(s):  
Primary Care ◽  
Viral Suppression ◽  
Retention In Care ◽  
Hiv Care ◽  
Women Living With Hiv ◽  
Care Visit ◽  
Retention In Hiv Care ◽  
Hiv Primary Care ◽  
Living With Hiv

Introduction. While increased healthcare engagement and antiretroviral therapy (ART) adherence occurs during pregnancy, women living with HIV (WLWH) are often lost to follow-up after delivery. We sought to evaluate postpartum retention in care and viral suppression and to identify associated factors among WLWH in a large public hospital in Atlanta, Georgia. Methods. Data from the time of entry into prenatal care until 24 months postpartum were collected by chart review from WLWH who delivered with ≥20 weeks gestational age from 2011 to 2016. Primary outcomes were retention in HIV care (two HIV care visits or viral load measurements >90 days apart) and viral suppression (<200 copies/mL) at 12 and 24 months postpartum. Obstetric and contraception data were also collected. Results. Among 207 women, 80% attended an HIV primary care visit in a mean 124 days after delivery. At 12 and 24 months, respectively, 47% and 34% of women were retained in care and 41% and 30% of women were virally suppressed. Attending an HIV care visit within 90 days postpartum was associated with retention in care at 12 months (aOR 3.66, 95%CI 1.72-7.77) and 24 months (aOR 4.71, 95%CI 2.00-11.10) postpartum. Receiving ART at pregnancy diagnosis (aOR 2.29, 95%CI 1.11-4.74), viral suppression at delivery (aOR 3.44, 95%CI 1.39-8.50), and attending an HIV care visit within 90 days postpartum (aOR 2.40, 95%CI 1.12-5.16) were associated with 12-month viral suppression, and older age (aOR 1.09, 95% CI 1.01-1.18) was associated with 24-month viral suppression. Conclusions. Long-term retention in HIV care and viral suppression are low in this population of postpartum WLWH. Prompt transition to HIV care in the postpartum period was the strongest predictor of optimal HIV outcomes. Efforts supporting women during the postpartum transition from obstetric to HIV primary care may improve long-term HIV outcomes in women.

scholarly journals Developing a triage tool for use in identifying people living with HIV who are at risk for non-retention in HIV care

2020 ◽  
Vol 31 (3) ◽  
pp. 244-253
Author(s):  
Merhawi T Gebrezgi ◽  
Kristopher P Fennie ◽  
Diana M Sheehan ◽  
Boubakari Ibrahimou ◽  
Sandra G Jones ◽  
...  
Keyword(s):  
At Risk ◽  
Human Immunodeficiency Virus ◽  
Risk Prediction ◽  
Risk Score ◽  
Retention In Care ◽  
Hiv Care ◽  
People Living With Hiv ◽  
Prediction Tool ◽  
Retention In Hiv Care ◽  
Immunodeficiency Virus

Identifying people living with human immunodeficiency virus (PLHIV) in human immunodeficiency virus (HIV) care who are at particular risk of non-retention in care is an important element in improving their HIV care outcomes. The purpose of this study was to develop a risk prediction tool to identify PLHIV at risk of non-retention in care over the course of the next year. We used stepwise logistic regression to assess sociodemographic, clinical and behavioral predictors of non-retention in HIV care. Retention in care was defined as having evidence of at least two encounters with an HIV care provider (or CD4 or viral load lab tests as a proxy measure for the encounter), at least three months apart within a year. We validated the risk prediction tool internally using the bootstrap method. The risk prediction tool included a total of six factors: age group, race, poverty level, homelessness, problematic alcohol/drug use, and viral suppression status. The total risk score ranged from 0 to 17. Compared to those in the lowest quartile (0 risk score), those who were in the middle two quartiles (score 1–4) and those in the upper quartile (>4 risk score) were more likely not to be retained in care (odds ratio [OR] 1.63 [confidence interval, CI: 1.39 – 1.92] and OR 4.82 [CI: 4.04 – 5.78], respectively). The discrimination ability for the prediction model was 0.651. We conclude that increased risk for non-retention in care can be predicted with routinely available variables. Since the discrimination of the tool was low, future studies may need to include more prognostic factors in the risk prediction tool.

scholarly journals The CombinADO study to assess the impact of a combination intervention strategy on viral suppression, antiretroviral therapy adherence, and retention in HIV care among adolescents and young people living with HIV: protocol for a cluster-randomized controlled trial

Trials ◽  
2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Phepo Mogoba ◽  
Maia Lesosky ◽  
Allison Zerbe ◽  
Joana Falcao ◽  
Claude Ann Mellins ◽  
...  
Keyword(s):  
Mental Health ◽  
Support Groups ◽  
Viral Suppression ◽  
Sub Saharan Africa ◽  
Hiv Care ◽  
People Living With Hiv ◽  
Retention In Hiv Care ◽  
Cluster Randomized ◽  
Living With Hiv ◽  
The Impact

Abstract Background Adolescents and youth living with HIV (AYAHIV) have worse HIV outcomes than other age groups, particularly in sub-Saharan Africa (SSA). AYAHIV in SSA face formidable health system, interpersonal- and individual-level barriers to retention in HIV care, uptake of ART, and achievement of viral suppression (VS), underscoring an urgent need for multi-component interventions to address these challenges. This cluster-randomized control trial (cRCT) aims to evaluate the effectiveness and monitor implementation of a community-informed multi-component intervention (“CombinADO strategy”) addressing individual-, facility-, and community-level factors to improve health outcomes for AYAHIV. Methods This trial will be conducted in 12 clinics in Nampula Province, Northern Mozambique. All clinics will implement an optimized standard of care (control) including (1) billboards/posters and radio shows, (2) healthcare worker (HCW) training, (3) one-stop adolescent and youth-friendly services, (4) information/motivation walls, (5) pill containers, and (6) tools to be used by HCW during clinical visits. The CombinADO strategy (intervention) will be superadded to control conditions at 6 randomly selected clinics. It will include five additional components: (1) peer support, (2) informational/motivational video, (3) support groups for AYAHIV caregivers, (4) AYAHIV support groups, and (5) mental health screening and linkage to adolescent-focused mental health support. The study conditions will be in place for 12 months; all AYAHIV (ages 10–24 years, on ART) seeking care in the participating sites will be exposed to either the control or intervention condition based on the clinic they attend. The primary outcome is VS (viral load < 50 copies/mL) at 12 months among AYAHIV attending participating clinics. Secondary outcomes include ART adherence (self-reported and TDF levels) and retention in care (engagement in the preceding 90 days). Uptake, feasibility, acceptability, and fidelity of the CombinADO strategy during implementation will be measured. Trial outcomes will be assessed in AYAHIV, caregivers, healthcare workers, and key informants. Statistical analyses will be conducted and reported in line with CONSORT guidelines for cRCTs. Discussion The CombinADO study will provide evidence on effectiveness and inform implementation of a novel community-informed multi-component intervention to improve retention, adherence, and VS among AYAHIV. If found effective, results will strengthen the rationale for scale up in SSA. Trial registration ClinicalTrials.gov NCT04930367. Registered on 18 June 2021

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