Geographic Variations in Retention in Care among HIV-Infected Adults in the United States.
<h4>Objective</h4>To understand geographic variations in clinical retention, a central component of the HIV care continuum and key to improving individual- and population-level HIV outcomes.<h4>Design</h4>We evaluated retention by US region in a retrospective observational st...
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Public Library of Science (PLoS)
2016-01-01
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| Series: | PLoS ONE |
| Online Access: | https://journals.plos.org/plosone/article/file?id=10.1371/journal.pone.0146119&type=printable |
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| author | Peter F Rebeiro Stephen J Gange Michael A Horberg Alison G Abraham Sonia Napravnik Hasina Samji Baligh R Yehia Keri N Althoff Richard D Moore Mari M Kitahata Timothy R Sterling Frank C Curriero North American AIDS Cohort Collaboration on Research and Design (NA-ACCORD) |
| author_facet | Peter F Rebeiro Stephen J Gange Michael A Horberg Alison G Abraham Sonia Napravnik Hasina Samji Baligh R Yehia Keri N Althoff Richard D Moore Mari M Kitahata Timothy R Sterling Frank C Curriero North American AIDS Cohort Collaboration on Research and Design (NA-ACCORD) |
| author_sort | Peter F Rebeiro |
| collection | DOAJ |
| description | <h4>Objective</h4>To understand geographic variations in clinical retention, a central component of the HIV care continuum and key to improving individual- and population-level HIV outcomes.<h4>Design</h4>We evaluated retention by US region in a retrospective observational study.<h4>Methods</h4>Adults receiving care from 2000-2010 in 12 clinical cohorts of the North American AIDS Cohort Collaboration on Research and Design (NA-ACCORD) contributed data. Individuals were assigned to Centers for Disease Control and Prevention (CDC)-defined regions by residential data (10 cohorts) and clinic location as proxy (2 cohorts). Retention was ≥2 primary HIV outpatient visits within a calendar year, >90 days apart. Trends and regional differences were analyzed using modified Poisson regression with clustering, adjusting for time in care, age, sex, race/ethnicity, and HIV risk, and stratified by baseline CD4+ count.<h4>Results</h4>Among 78,993 adults with 444,212 person-years of follow-up, median time in care was 7 years (Interquartile Range: 4-9). Retention increased from 2000 to 2010: from 73% (5,000/6,875) to 85% (7,189/8,462) in the Northeast, 75% (1,778/2,356) to 87% (1,630/1,880) in the Midwest, 68% (8,451/12,417) to 80% (9,892/12,304) in the South, and 68% (5,147/7,520) to 72% (6,401/8,895) in the West. In adjusted analyses, retention improved over time in all regions (p<0.01, trend), although the average percent retained lagged in the West and South vs. the Northeast (p<0.01).<h4>Conclusions</h4>In our population, retention improved, though regional differences persisted even after adjusting for demographic and HIV risk factors. These data demonstrate regional differences in the US which may affect patient care, despite national care recommendations. |
| format | Article |
| id | doaj-art-91ddbc816ae0466193d0549dd042db02 |
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| language | English |
| publishDate | 2016-01-01 |
| publisher | Public Library of Science (PLoS) |
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| spelling | doaj-art-91ddbc816ae0466193d0549dd042db022025-08-20T02:34:07ZengPublic Library of Science (PLoS)PLoS ONE1932-62032016-01-01111e014611910.1371/journal.pone.0146119Geographic Variations in Retention in Care among HIV-Infected Adults in the United States.Peter F RebeiroStephen J GangeMichael A HorbergAlison G AbrahamSonia NapravnikHasina SamjiBaligh R YehiaKeri N AlthoffRichard D MooreMari M KitahataTimothy R SterlingFrank C CurrieroNorth American AIDS Cohort Collaboration on Research and Design (NA-ACCORD)<h4>Objective</h4>To understand geographic variations in clinical retention, a central component of the HIV care continuum and key to improving individual- and population-level HIV outcomes.<h4>Design</h4>We evaluated retention by US region in a retrospective observational study.<h4>Methods</h4>Adults receiving care from 2000-2010 in 12 clinical cohorts of the North American AIDS Cohort Collaboration on Research and Design (NA-ACCORD) contributed data. Individuals were assigned to Centers for Disease Control and Prevention (CDC)-defined regions by residential data (10 cohorts) and clinic location as proxy (2 cohorts). Retention was ≥2 primary HIV outpatient visits within a calendar year, >90 days apart. Trends and regional differences were analyzed using modified Poisson regression with clustering, adjusting for time in care, age, sex, race/ethnicity, and HIV risk, and stratified by baseline CD4+ count.<h4>Results</h4>Among 78,993 adults with 444,212 person-years of follow-up, median time in care was 7 years (Interquartile Range: 4-9). Retention increased from 2000 to 2010: from 73% (5,000/6,875) to 85% (7,189/8,462) in the Northeast, 75% (1,778/2,356) to 87% (1,630/1,880) in the Midwest, 68% (8,451/12,417) to 80% (9,892/12,304) in the South, and 68% (5,147/7,520) to 72% (6,401/8,895) in the West. In adjusted analyses, retention improved over time in all regions (p<0.01, trend), although the average percent retained lagged in the West and South vs. the Northeast (p<0.01).<h4>Conclusions</h4>In our population, retention improved, though regional differences persisted even after adjusting for demographic and HIV risk factors. These data demonstrate regional differences in the US which may affect patient care, despite national care recommendations.https://journals.plos.org/plosone/article/file?id=10.1371/journal.pone.0146119&type=printable |
| spellingShingle | Peter F Rebeiro Stephen J Gange Michael A Horberg Alison G Abraham Sonia Napravnik Hasina Samji Baligh R Yehia Keri N Althoff Richard D Moore Mari M Kitahata Timothy R Sterling Frank C Curriero North American AIDS Cohort Collaboration on Research and Design (NA-ACCORD) Geographic Variations in Retention in Care among HIV-Infected Adults in the United States. PLoS ONE |
| title | Geographic Variations in Retention in Care among HIV-Infected Adults in the United States. |
| title_full | Geographic Variations in Retention in Care among HIV-Infected Adults in the United States. |
| title_fullStr | Geographic Variations in Retention in Care among HIV-Infected Adults in the United States. |
| title_full_unstemmed | Geographic Variations in Retention in Care among HIV-Infected Adults in the United States. |
| title_short | Geographic Variations in Retention in Care among HIV-Infected Adults in the United States. |
| title_sort | geographic variations in retention in care among hiv infected adults in the united states |
| url | https://journals.plos.org/plosone/article/file?id=10.1371/journal.pone.0146119&type=printable |
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