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Factors Associated With Returning to HIV Care After a Gap in Care in New York State

Cunningham, Chinazo O. MD, MS*; Buck, Johanna RN, MA; Shaw, Fiona M.; Spiegel, Laurence S. MS; Heo, Moonseong PhD; Agins, Bruce D. MD, MPH

JAIDS Journal of Acquired Immune Deficiency Syndromes: August 1st, 2014 - Volume 66 - Issue 4 - p 419–427
doi: 10.1097/QAI.0000000000000171
Epidemiology and Prevention

Background: Retention in HIV care has important implications. Few studies examining retention include comprehensive and heterogeneous populations, and few examine factors associated with returning to care after gaps in care. We identified reasons for gaps in care and factors associated with returning to care.

Methods: We extracted medical record and state-wide reporting data from 1865 patients with 1 HIV visit to a New York facility in 2008 and subsequent 6-month gap in care. Using mixed effect logistic regression, we examined sociodemographic, clinical, and facility characteristics associated with returning to care.

Results: Most patients were men (63.2%), black (51.4%), had Medicaid (53.9%). Many had CD4 counts >500 cells per cubic millimeter (34.4%) and undetectable viral loads (45.0%). Most (55.9%) had unknown reasons for gaps in care; of those with known reasons, reasons varied considerably. After a gap, 54.6% returned to care. Patients who did (vs. did not) return to care were more likely to have stable housing, longer duration of HIV, high CD4 count, suppressed viral load, antiretroviral medications, and had facilities attempt to contact them. Those who returned to care were less likely to be uninsured and have mental health problems or substance use histories.

Conclusion: Over half of our sample of patients in New York with 1 HIV visit and subsequent 6-month gap in care returned to care; no major reasons for gaps emerged. Nevertheless, our findings emphasize that stabilizing patients' psychosocial factors and contacting patients after a gap in care are key strategies to retain HIV-positive patients in care in New York.

*Division of General Internal Medicine, Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, NY;

Division of General Internal Medicine and the Department of Epidemiology and Population Health, Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, NY;

New York State Department of Health, AIDS Institute, New York, NY; and

Emory University School of Medicine, Atlanta, GA.

Correspondence to: Chinazo O. Cunningham, MD, MS, Albert Einstein College of Medicine, Montefiore Medical Center, 111 E. 210th Street, Bronx, NY 10467 (e-mail: ccunning@montefiore.org).

Supported in part by the Center for AIDS Research at the Albert Einstein College of Medicine and Montefiore Medical Center (NIH AI-51519).

The authors have no conflicts of interest to disclose.

Received April 09, 2014

Accepted April 09, 2014

© 2014 by Lippincott Williams & Wilkins