Abstract
Irregular participation in HIV medical care hinders HIV RNA suppression and impacts health among people living with HIV. Cluster analysis of clinical data from 1,748 patients attending a large academic medical center yielded three HIV service usage patterns, namely: ‘engaged in care’, ‘sporadic care’, and ‘frequent use’. Patients ‘engaged in care’ exhibited most consistent retention (on average, >88 % of each patient’s observation years had ≥2 visits 90 days apart), annualized visit use (2.9 mean visits/year) and viral suppression (>73 % HIV RNA tests <400 c/mL). Patients in ‘sporadic care’ demonstrated lower retention (46–52 %), visit use (1.7 visits/year) and viral suppression (56 % <400 c/mL). Patients with ‘frequent use’ (5.2 visits/year) had more inpatient and emergency visits. Female, out-of-state residence, low attendance during the first observation year and detectable first-observed HIV RNA were early predictors of subsequent service usage. Patients ‘engaged in care’ were more likely to have HIV RNA <400 than those receiving sporadic care. Results confirm earlier findings that under-utilization of services predicts poorer viral suppression and health outcomes and support recommendations for 2–3 visits/year.
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Acknowledgments
This research was supported by funds from HRSA’s Special Projects of National Significance program (HA15148, H9HA15152), UNC Centers for AIDS Research (P30-AI50410) and the National Center for Advancing Translational Sciences (NCATS), National Institutes of Health (1UL1TR001111). This study was conducted with the approval of the University of North Carolina at Chapel Hill Institutional Review. The authors also acknowledge the clinic staff, providers, and patients for their invaluable contributions to this research. The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH or HRSA.
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Palma, A., Lounsbury, D.W., Messer, L. et al. Patterns of HIV Service Use and HIV Viral Suppression Among Patients Treated in an Academic Infectious Diseases Clinic in North Carolina. AIDS Behav 19, 694–703 (2015). https://doi.org/10.1007/s10461-014-0907-8
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DOI: https://doi.org/10.1007/s10461-014-0907-8