September 8, 2017
This article originally appeared on The Body.
Slightly more than half of U.S. adults with HIV had occasional 180-day gaps in their HIV primary care in a 4,275-person analysis of the HIV Research Network (HIVRN). But just more than half of people with occasional care gaps filled a prescription for antiretroviral therapy (ART) during a gap. The findings have implications not only for HIV care, but also for how researchers measure retention in care.
Retention in HIV care, often defined as clinic visits at least twice a year separated by 90 days, facilitates ART prescribing and monitoring and thus can be essential to HIV control. Research links worse retention to inconsistent viral control, lower CD4 counts and mortality. Authors of the new study observe that some HIV clinicians feel comfortable seeing stable patients once yearly and checking HIV RNA and other values twice yearly. The standard retention definition would classify such patients as not retained in care, even though these patients may continue ART and maintain viral suppression during apparent gaps in care. The new retention analysis aimed to determine whether people filled an ART prescription during gaps in care and to identify factors that predict prescriptions during gaps.
The analysis involved adults in care for HIV at five HIVRN sites in Massachusetts, Maryland and New York during an observation period from January 2006 through December 2010. The investigators determined which of these patients used Medicaid, an indicator of low income. They defined a gap in care as 180 or more days without a visit to an HIVRN outpatient HIV clinic, and they classified patients as never in a gap, always in a gap or occasionally in a gap.