title: Social determinants of health and retention in HIV care in a clinical cohort in Ontario, Canada.
abstract: Continuous HIV care supports antiretroviral therapy initiation and adherence, and prolongs survival. We investigated the association of social determinants of health (SDH) and subsequent retention in HIV care in a clinical cohort in Ontario, Canada. The Ontario HIV Treatment Network Cohort Study is a multi-site cohort of patients at 10 HIV clinics. Data were collected from medical charts, interviews, and via record linkage with the provincial public health laboratory for viral load tests. For participants interviewed in 2009, we used three-category multinomial logistic regression to identify predictors of retention in 2010-2012, defined as (1) continuous care (≥2 viral loads ≥90 days in all years; reference category); (2) discontinuous care (only 1 viral load/year in ≥1 year); and (3) a gap in care (≥1 year in 2010-2012 with no viral load). In total, 1838 participants were included. In 2010-2012, 71.7% had continuous care, 20.9% had discontinuous care, and 7.5% had a gap in care. Discontinuous care in 2009 was predictive (p < .0001) of future retention. SDH associated with discontinuous care were Indigenous ethnicity, being born in Canada, being employed, reporting hazardous drinking, and non-injection drug use. Being a heterosexual male was associated with having a gap in care, and being single and younger were associated with discontinuous care and a gap in care. Various SDH were associated with retention. Care discontinuity was highly predictive of future gaps. Targeted strategic interventions that better engage those at risk of suboptimal retention merit exploration.
  
  
  
  AOR: adjusted odds ratio; ART: antiretroviral therapy; AUDIT: Alcohol Use Disorders Identification Test; CES-D: Center for Epidemiologic Studies Depression Scale; CIs: confidence intervals; HIV: human immunodeficiency virus; IQR: interquartile range; MSM: men who have sex with men; NA-ACCORD: North American AIDS Cohort Collaboration on Research and Design; OCS: Ontario HIV Treatment Network Cohort Study; OHTN: Ontario HIV Treatment Network; OR: odds ratio; PHOL: Public Health Ontario Laboratories; REB: Research Ethics Board; SDH: social determinants of health; US: United States.
authors.affiliation: a Ontario HIV Treatment Network , Toronto , Canada.|b Division of Clinical Public Health, Dalla Lana School of Public Health , University of Toronto , Toronto , Canada.
authors.forename: Beth
authors.initials: B
authors.lastname: Rachlis
authors.affiliation: c Division of Epidemiology , Dalla Lana School of Public Health, University of Toronto , Toronto , Canada.|d Department of Family and Community Medicine , St. Michael's Hospital, Toronto , Canada.|e Department of Family and Community Medicine , University of Toronto , Toronto , Canada.|f Li Ka Shing Knowledge Institute, St. Michael's Hospital , Toronto , Canada.
authors.forename: Ann N
authors.initials: AN
authors.lastname: Burchell
authors.affiliation: g Division of Biostatistics, Dalla Lana School of Public Health , University of Toronto , Toronto , Canada.|h Rotman Research Institute , Baycrest, Toronto , Canada.
authors.forename: Sandra
authors.initials: S
authors.lastname: Gardner
authors.affiliation: a Ontario HIV Treatment Network , Toronto , Canada.
authors.forename: Lucia
authors.initials: L
authors.lastname: Light
authors.affiliation: g Division of Biostatistics, Dalla Lana School of Public Health , University of Toronto , Toronto , Canada.|i Toronto General Research Institute, University Health Network , Toronto , Canada.
authors.forename: Janet
authors.initials: J
authors.lastname: Raboud
authors.affiliation: d Department of Family and Community Medicine , St. Michael's Hospital, Toronto , Canada.|e Department of Family and Community Medicine , University of Toronto , Toronto , Canada.|f Li Ka Shing Knowledge Institute, St. Michael's Hospital , Toronto , Canada.
authors.forename: Tony
authors.initials: T
authors.lastname: Antoniou
authors.affiliation: a Ontario HIV Treatment Network , Toronto , Canada.
authors.forename: Jean
authors.initials: J
authors.lastname: Bacon
authors.affiliation: j Women's College Research Institute, Women's College Hospital , Toronto , Canada.
authors.forename: Anita
authors.initials: A
authors.lastname: Benoit
authors.affiliation: k Ottawa Hospital Research Institute , Ottawa , Canada.
authors.forename: Curtis
authors.initials: C
authors.lastname: Cooper
authors.affiliation: l Bruyère Research Institute , Ottawa , Canada.|m Department of Family Medicine , University of Ottawa , Ottawa , Canada.
authors.forename: Claire
authors.initials: C
authors.lastname: Kendall
authors.affiliation: n Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health , Toronto , Canada.|o Department of Medicine , Women's College Research Institute, Women's College Hospital , Toronto , Canada.|p Department of Medicine , University of Toronto , Toronto , Canada.
authors.forename: Mona
authors.initials: M
authors.lastname: Loutfy
authors.affiliation: q Department of Medicine , Queen's University , Kingston , Canada.|r Hotel Dieu Hospital , Kingston , Canada.
authors.forename: Wendy
authors.initials: W
authors.lastname: Wobeser
authors.affiliation: s AIDS Bureau, Ontario Ministry of Health and Long Term Care , Toronto , Canada.
authors.forename: Frank
authors.initials: F
authors.lastname: McGee
authors.affiliation: p Department of Medicine , University of Toronto , Toronto , Canada.|t Sunnybrook Health Science Centre , Toronto , Canada.
authors.forename: Anita
authors.initials: A
authors.lastname: Rachlis
authors.affiliation: a Ontario HIV Treatment Network , Toronto , Canada.|f Li Ka Shing Knowledge Institute, St. Michael's Hospital , Toronto , Canada.|u Department of Psychiatry , University of Toronto , Toronto , Canada.
authors.forename: Sean B
authors.initials: SB
authors.lastname: Rourke
authors.affiliation: a Ontario HIV Treatment Network , Toronto , Canada.
mesh_terms: D000328:Adult; D000367:Age Factors; D019380:Anti-HIV Agents / Q000627:therapeutic use*; D015331:Cohort Studies; D005260:Female; D015658:HIV Infections / Q000188:drug therapy* / Q000523:psychology; D006801:Humans; D008297:Male; D008875:Middle Aged; D009864:Ontario / Q000453:epidemiology; D010349:Patient Compliance; D012725:Sexual Behavior; D064890:Social Determinants of Health; D016896:Treatment Outcome; D019562:Viral Load
chemical_list: D019380:Anti-HIV Agents
keywords: Canada; HIV; Retention; clinical cohort; gaps in care; social determinants of health