Chronic Disease

About three fourths of patients in the United States estimated to remain in HIV care

Keeping patients with HIV in continued care (retention) is critical for successful treatment outcomes and survival. It may also reduce HIV transmission in the community and lower costs. Recently, John A. Fleishman from the Agency for Healthcare Research and Quality and others compared three different measures of retention in a large group of HIV patients. Retention rates ranged from 71 percent to 75 percent. Certain groups were at an increased risk for low retention. Data were retrieved from the medical records of 17,425 patients with HIV infection. All were receiving their care at 12 HIV clinical sites located in various geographic regions of the United States.
Three measures of retention were used. One measure was the proportion of time not spent in a gap of more than 6 months between successive outpatient visits. The second measure was the proportion of 91-day quarters during which at least 1 visit took place. Finally, the third measure was the proportion of years where two or more visits were separated by at least 90 days. On average, 71 percent of time in care was not spent in a gap of more than 6 months. Also, 73 percent of all quarters had at least one patient visit. For the third measure, 75 percent of all years had at least 2 visits separated by at least 90 days.
Retention rates were highest for women, whites, older individuals, and men having sex with men (MSM). An initial CD4 T lymphocyte cell count of 50 cells/µl or less (an indicator of more advanced disease) was also associated with a higher retention rate. Groups at greater risk for low retention rates included younger patients, men, blacks, non-MSM risk groups, and individuals with higher initial CD4 cell counts.
More details are in "Comparing different measures of retention in outpatient HIV care," by Baligh R. Yehia, M.D., Dr. Fleishman, Joshua P. Metlay, M.D., Ph.D., and others in the June 1, 2012, AIDS 26(9), pp. 1131-1139. Reprints (AHRQ Publication No. 12-R064) are available from the AHRQ Publications Clearinghouse.

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