Strong agreement of nationally recommended retention measures from the Institute of Medicine and Department of Health and Human Services.
OBJECTIVE
We sought to quantify agreement between Institute of Medicine (IOM) and Department of Health and Human Services (DHHS) retention indicators, which have not been compared in the same population, and assess clinical retention within the largest HIV cohort collaboration in the U.S.


METHODS
Observational study from 2008-2010, using clinical cohort data in the North American AIDS Cohort Collaboration on Research and Design (NA-ACCORD).


METHODS
Retention definitions used HIV primary care visits. The IOM retention indicator was: ≥2 visits, ≥90 days apart, each calendar year. This was extended to a 2-year period; retention required meeting the definition in both years. The DHHS retention indicator was: ≥1 visit each semester over 2 years, each ≥60 days apart. Kappa statistics detected agreement between indicators and C statistics (areas under Receiver-Operating Characteristic curves) from logistic regression analyses summarized discrimination of the IOM indicator by the DHHS indicator.


RESULTS
Among 36,769 patients in 2008-2009 and 34,017 in 2009-2010, there were higher percentages of participants retained in care under the IOM indicator than the DHHS indicator (80% vs. 75% in 2008-2009; 78% vs. 72% in 2009-2010, respectively) (p<0.01), persisting across all demographic and clinical characteristics (p<0.01). There was high agreement between indicators overall (κ = 0.83 in 2008-2009; κ = 0.79 in 2009-2010, p<0.001), and C statistics revealed a very strong ability to predict retention according to the IOM indicator based on DHHS indicator status, even within characteristic strata.


CONCLUSIONS
Although the IOM indicator consistently reported higher retention in care compared with the DHHS indicator, there was strong agreement between IOM and DHHS retention indicators in a cohort demographically similar to persons living with HIV/AIDS in the U.S. Persons with poorer retention represent subgroups of interest for retention improvement programs nationally, particularly in light of the White House Executive Order on the HIV Care Continuum.
Johns Hopkins University, Baltimore, MD, United States of America.
Peter F
PF
Rebeiro
Kaiser Permanente Mid-Atlantic States, Rockville, MD, United States of America.
Michael A
MA
Horberg
Johns Hopkins University, Baltimore, MD, United States of America.
Stephen J
SJ
Gange
Johns Hopkins University, Baltimore, MD, United States of America.
Kelly A
KA
Gebo
University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, United States of America.
Baligh R
BR
Yehia
Centers for Disease Control and Prevention, Atlanta, GA, United States of America.
John T
JT
Brooks
Centers for Disease Control and Prevention, Atlanta, GA, United States of America.
Kate
K
Buchacz
Kaiser Permanente Northern California, Oakland, CA, United States of America.
Michael J
MJ
Silverberg
University of Calgary, Calgary, AB, Canada.
John
J
Gill
Johns Hopkins University, Baltimore, MD, United States of America.
Richard D
RD
Moore
Johns Hopkins University, Baltimore, MD, United States of America.
Keri N
KN
Althoff
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D003430:Cross-Sectional Studies; D005260:Female; D015658:HIV Infections / Q000188:drug therapy / Q000453:epidemiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D015969:National Academies of Science, Engineering, and Medicine, U.S., Health and Medicine Division; D014481:United States; D014483:United States Dept. of Health and Human Services / Q000458:organization & administration; D055815:Young Adult