title: Factors associated with returning to HIV care after a gap in care in New York State.
abstract: BACKGROUND
  Retention in HIV care has important implications. Few studies examining retention include comprehensive and heterogeneous populations, and few examine factors associated with returning to care after gaps in care. We identified reasons for gaps in care and factors associated with returning to care.
  
  
  METHODS
  We extracted medical record and state-wide reporting data from 1865 patients with 1 HIV visit to a New York facility in 2008 and subsequent 6-month gap in care. Using mixed effect logistic regression, we examined sociodemographic, clinical, and facility characteristics associated with returning to care.
  
  
  RESULTS
  Most patients were men (63.2%), black (51.4%), had Medicaid (53.9%). Many had CD4 counts >500 cells per cubic millimeter (34.4%) and undetectable viral loads (45.0%). Most (55.9%) had unknown reasons for gaps in care; of those with known reasons, reasons varied considerably. After a gap, 54.6% returned to care. Patients who did (vs. did not) return to care were more likely to have stable housing, longer duration of HIV, high CD4 count, suppressed viral load, antiretroviral medications, and had facilities attempt to contact them. Those who returned to care were less likely to be uninsured and have mental health problems or substance use histories.
  
  
  CONCLUSIONS
  Over half of our sample of patients in New York with 1 HIV visit and subsequent 6-month gap in care returned to care; no major reasons for gaps emerged. Nevertheless, our findings emphasize that stabilizing patients' psychosocial factors and contacting patients after a gap in care are key strategies to retain HIV-positive patients in care in New York.
authors.affiliation: *Division of General Internal Medicine, Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, NY; †Division of General Internal Medicine and the Department of Epidemiology and Population Health, Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, NY; ‡New York State Department of Health, AIDS Institute, New York, NY; and ‖Emory University School of Medicine, Atlanta, GA.
authors.forename: Chinazo O
authors.initials: CO
authors.lastname: Cunningham
authors.forename: Johanna
authors.initials: J
authors.lastname: Buck
authors.forename: Fiona M
authors.initials: FM
authors.lastname: Shaw
authors.forename: Laurence S
authors.initials: LS
authors.lastname: Spiegel
authors.forename: Moonseong
authors.initials: M
authors.lastname: Heo
authors.forename: Bruce D
authors.initials: BD
authors.lastname: Agins
mesh_terms: D000328:Adult; D019380:Anti-HIV Agents / Q000627:therapeutic use*; D018791:CD4 Lymphocyte Count; D005260:Female; D015658:HIV Infections / Q000188:drug therapy* / Q000453:epidemiology*; D006296:Health Services / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D009518:New York / Q000453:epidemiology; D016017:Odds Ratio; D012189:Retrospective Studies; D012307:Risk Factors; D019562:Viral Load
chemical_list: D019380:Anti-HIV Agents
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