title: Multiple gaps in care common among newly diagnosed HIV patients.
abstract: The objective of this study was to identify frequency and predictors of gaps in care in a longitudinal cohort of HIV-infected patients in urban New England. We conducted a retrospective cohort study in Providence, RI, of 581 newly diagnosed HIV patients >18 entering into care from 2004 to 2010, and followed their care through the end of 2011. The outcome of interest was gaps in care, defined as an interruption of medical care for >6 months. Time to the first gap was characterized using Kaplan-Meier (KM) curves. Anderson-Gill proportional hazards (AGPH) model was used to identify the risk factors of recurrent gaps in care. During the study period, 368 patients (63%) experienced at least 1 gap in care, 178 (30%) had ≥2 gaps, 84 (14.5%) had ≥3 gaps, and 21 (3.6%) died; 77% of the gaps were followed by a re-linkage with care The KM curves estimate that one-quarter of patients (95% CI = 22-29%) would experience ≥1 gap in care by Year 1; nearly one-half (CI = 45-54%) by Year 2; and 90% (CI = 93-96%) by Year 8. A prior gap was a strong predictor (HR = 2.36; CI = 2.16-2.58) of subsequent gaps; other predictors included age <25 (HR = 1.29; CI = 1.04-1.60), and no prescription of ART in first year of care (HR = 1.23; CI = 1.01-1.50). The results of this study suggest that a significant proportion of newly diagnosed HIV-infected patients will experience multiple gaps in care and yet re-engagement is possible. Interventions should focus on both prevention of gaps as well as re-engaging those lost to follow-up.
authors: a Department of Medicine , Alpert Medical School of Brown University, The Miriam Hospital , Providence , RI , USA.
authors: Aadia I
authors: AI
authors: Rana
authors: Tao
authors: T
authors: Liu
authors: Fizza S
authors: FS
authors: Gillani
authors: Rebecca
authors: R
authors: Reece
authors: Erna M
authors: EM
authors: Kojic
authors: Caron
authors: C
authors: Zlotnick
authors: Ira B
authors: IB
authors: Wilson
mesh_terms: D000328:Adult; D019380:Anti-HIV Agents / Q000627:therapeutic use*; D003266:Continuity of Patient Care / Q000458:organization & administration / Q000706:statistics & numerical data*; D005260:Female; D015658:HIV Infections / Q000188:drug therapy / Q000453:epidemiology*; D006301:Health Services Needs and Demand / Q000458:organization & administration / Q000706:statistics & numerical data*; D006801:Humans; D053208:Kaplan-Meier Estimate; D008137:Longitudinal Studies; D059012:Lost to Follow-Up; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012237:Rhode Island / Q000453:epidemiology; D012307:Risk Factors; D016903:Drug Monitoring
chemical_list: D019380:Anti-HIV Agents
keywords: HIV; gaps; retention in care; treatment adherence
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