Consistent engagement in care is associated with positive health outcomes among people living with HIV (PLWH). However, traditional retention measures ignore the evolving dynamics of engagement in care. To understand the longitudinal patterns of HIV care, we analyzed medical records from 2008 to 2015 of PLWH ≥ 18 years-old receiving care at a public, hospital-based HIV clinic (N = 2110). Using latent class analysis, we identified five distinct care trajectory classes: (1) consistent care (N = 1281); (2) less frequent care (N = 270); (3) return to care after initial attrition (N = 192); (4) moderate attrition (N = 163); and (5) rapid attrition (N = 204). The majority of PLWH in Class 1 (73.9%) had achieved sustained viral suppression (viral load ≤ 200 copies/mL at last test and > 12 months prior) by study end. Among the other care classes, there was substantial variation in sustained viral suppression (61.1% in Class 2 to 3.4% in Class 5). Care trajectories could be used to prioritize re-engagement efforts.
Bibliographical noteFunding Information:
Funding for this study was provided by the National Institute for Allergy and Infectious Disease of the National Institutes of Health under Award No. K25AI118476 (PI: Enns). The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. The authors wish to acknowledge Allison La Pointe and Jessica Munroe at the Minnesota Department of Health for facilitating the merging of clinic data with state surveillance data and Dr. Tenko Raykov at Michigan State University for early discussions on the application of latent class methods in this analysis. Funding for this study was provided by the National Institute for Allergy and Infectious Disease of the National Institutes of Health under Award No. K25AI118476 (PI: Enns). Portions of this analysis were presented at the 38th Annual Meeting of the Society for Medical Decision Making, Oct. 23?24, 2016 and at the 2018 Conference on Retroviruses and Opportunistic Infections (CROI), March 4?7, 2018.
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- Care patterns
- Latent class analysis
- Retention in care
- Sustained viral suppression