Background
“Ending the HIV Epidemic in the US Initiative” strategies include supporting retention and re-engagement in care for people with HIV (PWH) (CDC EHE pillars). As part of a multidisciplinary initiative to enhance retention in care among PWH at our clinic, we hypothesized that we could identify demographic differences between patients who are and are not retained in care to inform targeted outreach efforts.
Methods
This is a single-center, retrospective, observational study using data collected during routine clinic visits between November 2021 and October 2023. We collected demographic, healthcare utilization, and viral load data for all PWH seen at least once in our clinic during the study period. Based on CMS Quality ID #340, retention in care was defined as seen at least two times between November 2022 and October 2023 and one additional time between November 2021 and October 2022. Viral suppression was defined as most recent viral load less than two hundred copies per milliliter. We compared characteristics of PWH retained or not using chi-squared tests.
Results
We found that compared to PWH not retained (n=406), those who are retained (n=977) were more likely to be over 55 years old, the median age of the study population, (61% vs 51%, p<0.001) and to live within 8 miles of clinic, the median distance of the study population, (68% vs 56%, p<0.001), but were not more likely to be virally suppressed (94% vs 92%, p=0.058). Among those not retained, we found no differences in demographics between those virally suppressed (n=372) or not (n=34). Among those retained, we found that compared to those who are virally suppressed (n=922), those who are not (n=55) are more likely to identify as Black or African American (AA) (55% vs 37%, p=0.011) or to live in an under-resourced ZIP (56% vs 42%, p=0.042).
Conclusions
Our results show different demographic factors are associated with retention in care and with viral suppression among PWH seen in our clinic. We also found retention was not associated with viral suppression, suggesting that in an era of well tolerated ART, some PWH likely achieve virologic success without semiannual medical encounters. Furthermore, our results suggest historically marginalized populations may not achieve optimal health outcomes with traditional healthcare delivery targets and may be better served with alternative strategies.