title: Moving toward a novel and comprehensive behavioral composite of engagement in HIV care.
abstract: Suboptimal engagement in HIV care increases the risk of HIV-related morbidity and mortality; however, a comprehensive and practical measure of engagement in care does not exist. The objective of our study was to identify and develop a composite of engagement in HIV care. From May to August 2013, we conducted a cross-sectional study of HIV-positive individuals who consented to participate in an online survey. Engagement in care was assessed by the following self-reported variables: (1) having attended an HIV health-care provider appointment in the past six months, (2) reporting a scheduled future HIV health-care provider appointment, (3) knowing their last CD4(+) cell count, (4) knowing their antiretroviral (ARV) medication names, (5) reporting ARV adherence ≥80% on the visual analog scale (VAS) and rating scale, (6) reporting adherence ≥90% on the VAS and rating scale, and (7) not having missed all ARVs for at least four days in a row in the past three months. To create the composite of engagement in care, the presence or absence of these variables were summed and categorized (7 = "high engagement," 5-6 = "moderate engagement," and 0-4 = "low engagement"). We examined the correlation between this composite and self-reported HIV viral load (VL; detectable versus undetectable) in a logistic regression model. We surveyed 1259 HIV-positive individuals: 85% reporting an undetectable VL and 67% reporting excellent adherence. Approximately 89%, 88%, and 67% of those with high, moderate, and low engagement, respectively, had an undetectable VL. Having moderate engagement was associated with 3.5-fold higher odds, and high engagement was associated with 4.0-fold higher odds of virologic undetectability compared to low engagement (overall p-value < 0.0001). Our data indicate that this novel and comprehensive composite of engagement may be a useful tool in clinical and research settings given its high correlation with virologic outcomes. Future research should validate this composite in other populations and examine it prospectively.
authors.affiliation: a Department of Medicine , University of California, San Francisco , San Francisco , CA , USA.
authors.forename: Parya
authors.initials: P
authors.lastname: Saberi
authors.forename: Mallory O
authors.initials: MO
authors.lastname: Johnson
mesh_terms: D000328:Adult; D019380:Anti-HIV Agents / Q000627:therapeutic use*; D023241:Antiretroviral Therapy, Highly Active; D003430:Cross-Sectional Studies; D005260:Female; D015658:HIV Infections / Q000188:drug therapy* / Q000821:virology; D006801:Humans; D008297:Male; D008875:Middle Aged; D010342:Patient Acceptance of Health Care; D010349:Patient Compliance; D019562:Viral Load
chemical_list: D019380:Anti-HIV Agents
keywords: HIV; adherence; continuum of care; engagement in care; retention in care