title: Patterns of HIV service use and HIV viral suppression among patients treated in an academic infectious diseases clinic in North Carolina.
abstract: Irregular participation in HIV medical care hinders HIV RNA suppression and impacts health among people living with HIV. Cluster analysis of clinical data from 1,748 patients attending a large academic medical center yielded three HIV service usage patterns, namely: 'engaged in care', 'sporadic care', and 'frequent use'. Patients 'engaged in care' exhibited most consistent retention (on average, >88 % of each patient's observation years had ≥2 visits 90 days apart), annualized visit use (2.9 mean visits/year) and viral suppression (>73 % HIV RNA tests <400 c/mL). Patients in 'sporadic care' demonstrated lower retention (46-52 %), visit use (1.7 visits/year) and viral suppression (56 % <400 c/mL). Patients with 'frequent use' (5.2 visits/year) had more inpatient and emergency visits. Female, out-of-state residence, low attendance during the first observation year and detectable first-observed HIV RNA were early predictors of subsequent service usage. Patients 'engaged in care' were more likely to have HIV RNA <400 than those receiving sporadic care. Results confirm earlier findings that under-utilization of services predicts poorer viral suppression and health outcomes and support recommendations for 2-3 visits/year.
authors.affiliation: Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY, USA, ap3223@columbia.edu.
authors.forename: Anton
authors.initials: A
authors.lastname: Palma
authors.forename: David W
authors.initials: DW
authors.lastname: Lounsbury
authors.forename: Lynne
authors.initials: L
authors.lastname: Messer
authors.forename: Evelyn Byrd
authors.initials: EB
authors.lastname: Quinlivan
mesh_terms: D000046:Academic Medical Centers; D000328:Adult; D000554:Ambulatory Care Facilities; D023241:Antiretroviral Therapy, Highly Active; D016000:Cluster Analysis; D015331:Cohort Studies; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data; D005260:Female; D015658:HIV Infections / Q000097:blood / Q000188:drug therapy*; D006296:Health Services / Q000706:statistics & numerical data*; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D055552:Infectious Disease Medicine; D007348:Insurance, Health; D008297:Male; D008875:Middle Aged; D009657:North Carolina; D010358:Patient Participation; D012111:Residence Characteristics; D012737:Sex Factors; D016896:Treatment Outcome; D019562:Viral Load