Journal of AIDS & Clinical Research

An Interrupted Continuum of Care? What are the Risk Factors and Comorbidities Related to Long-Term Engagement and Retention in HIV Care?

Abstract

Mari-Lynn Drainoni, Kathleen M. Carey, Jake R Morgan, Cindy L. Christiansen, M Maya McDoom, Monica Malowney and Meg Sullivan

Despite the importance of continuous care, a large proportion of persons with HIV are not engaged or retained in care at any one time, leading to poor outcomes. Identifying the risk factors associated with lack of engagement and retention in HIV care is needed in order to target patients for interventions. While both engagement and retention in care have been studied using multiple measures, the observation period for the majority of studies is less than one year, few studies have examined both initial engagement and retention, and the effect of comorbidities has typically not been included. This study extends the literature by examining how comorbidities, in addition to demographics, HIV clinical indicators and transmission risk factors, were associated with engagement and retention in a cohort study of 485 HIV-infected persons seen for an initial HIV visit at an urban safety-net hospital. Using the electronic medical record, demographic, risk factor, health status and comorbidity data were gathered at the time of initial visits. To measure engagement and retention, appointment data were obtained for a 24-month period following the initial visit. Key findings were that unknown HIV transmission risk factor and being homeless at initial visit were associated with both lack of engagement and retention. Conversely being diagnosed with a psychiatric disorder was predictive of retention. Our findings have important implications for program structure, including the integration of care, as well as regarding key components to be addressed holistically in early clinic visits.