title: Factors associated with non-retention in HIV care in an era of widespread antiretroviral therapy.
abstract: In an era of antiretroviral therapy (ART) for all HIV-1-infected patients, our primary aim was to describe prevalence and characteristics of patients disengaged from care at an urban ambulatory HIV clinic. We conducted a nested case-control study. All patients who disengaged from care (defined as being lost to follow-up for at least one year) from 2007 to 2014 inclusive were identified. Cases were matched to controls in a 1:4 ratio. A total of 1250 cases were included; 250/2289 (10.9%) of patients attending our HIV clinic disengaged from 2007 to 2014. One hundred and twenty-six (50.4%) were heterosexual, 81 (32.4%) were men who have sex with men and 40 (16%) were intravenous drug users. On univariate analysis only, patients with heterosexual risk were more likely to disengage from care (50.4% vs. 33.7%, p: <0.001). Those who disengaged were younger, mean age of 39 (p: <0.001). A higher proportion of patients who disengaged from care was not receiving ART and did not have a suppressed HIV-1 viral load (p: <0.001). On multivariable analysis, Irish patients were less likely to disengage from HIV care (odds ratio: 0.567, p: 0.002). Factors associated with non-retention in HIV care have been identified. A semi-structured interview of those patients who re-engaged will take place to further examine reasons for disengagement from care.
authors: St James's Hospital, St James's Hospital, Dublin, Ireland.
authors: Sarah
authors: S
authors: O'Connell
authors: St James's Hospital, St James's Hospital, Dublin, Ireland.
authors: Anna
authors: A
authors: O'Rourke
authors: St James's Hospital, St James's Hospital, Dublin, Ireland.
authors: Eileen
authors: E
authors: Sweeney
authors: St James's Hospital, St James's Hospital, Dublin, Ireland.
authors: Almida
authors: A
authors: Lynam
authors: St James's Hospital, St James's Hospital, Dublin, Ireland.
authors: Corinna
authors: C
authors: Sadlier
authors: St James's Hospital, St James's Hospital, Dublin, Ireland.
authors: Colm
authors: C
authors: Bergin
mesh_terms: D000328:Adult; D000554:Ambulatory Care Facilities; D019380:Anti-HIV Agents / Q000627:therapeutic use*; D018791:CD4 Lymphocyte Count; D016022:Case-Control Studies; D005260:Female; D015658:HIV Infections / Q000188:drug therapy* / Q000523:psychology; D006801:Humans; D059012:Lost to Follow-Up; D008297:Male; D055118:Medication Adherence; D008875:Middle Aged; D010342:Patient Acceptance of Health Care / Q000523:psychology*; D015995:Prevalence; D012307:Risk Factors
chemical_list: D019380:Anti-HIV Agents
keywords: Human immunodeficiency virus; antiretroviral therapy; lost to follow-up; retention in care