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The Association of Unmet Needs With Subsequent Retention in Care and HIV Suppression Among Hospitalized Patients With HIV Who Are Out of Care

Dandachi, Dima, MD*; May, Sarah B., MS†,‡; Davila, Jessica A., PhD†,‡; Cully, Jeffrey, PhD†,‡,§; Amico, K. Rivet, PhD; Kallen, Michael A., PhD, MPH; Giordano, Thomas P., MD, MPH*,†,‡

JAIDS Journal of Acquired Immune Deficiency Syndromes: January 1, 2019 - Volume 80 - Issue 1 - p 64–72
doi: 10.1097/QAI.0000000000001874
Implementation Science
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Background: Unmet needs among hospitalized patients with HIV may prevent engagement in HIV care leading to worse clinical outcomes. Our aim was to examine the role of unmet subsistence needs (eg, housing, transportation, and food) and medical needs (eg, mental health and substance abuse treatment) as barriers for retention in HIV care and viral load (VL) suppression.

Methods: We used data from the Mentor Approach for Promoting Patients' Self-Care intervention study, the enrolled hospitalized HIV patients at a large publicly funded hospital between 2010 and 2013, who were out-of-care. We examined the effect of unmet needs on retention in HIV care (attended HIV appointments within 0–30 days and 30–180 days) and VL suppression, 6 months after discharge.

Results: Four hundred seventeen participants were enrolled, 78% reported having ≥1 unmet need at baseline, most commonly dental care (55%), financial (43%), or housing needs (34%). Participants with unmet needs at baseline, compared to those with no needs, were more likely to be African American, have an existing HIV diagnosis and be insured. An unmet need for transportation was associated with lower odds of retention in care [odds ratio (OR): 0.5; 95% confidence interval (CI): 0.34 to 0.94, P = 0.03], even after adjusting for other factors. Compared to participants with no need, those who reported ≥3 unmet subsistence needs were less likely to demonstrate VL improvement (OR: 0.51; 95% CI: 0.28 to 0.92; P = 0.03) and to be retained in care (OR: 0.52; 95% CI: 0.28 to 0.95; P = 0.03).

Conclusion: Broader access to programs that can assist in meeting subsistence needs among hospitalized patients could have significant individual and public health benefits.

*Section of Infectious Diseases, Department of Medicine, Baylor College of Medicine, Houston, TX;

Center for Innovations in Quality, Effectiveness, and Safety, Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX;

Section of Health Services Research, Department of Medicine, Baylor College of Medicine, Houston, TX;

§Department of Psychiatry, Baylor College of Medicine, Houston, TX;

Department of Health Behavior and Health Education, School of Public Health, University of Michigan, Ann Arbor, MI; and

Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL.

Correspondence to: Thomas P. Giordano, MD, MPH, Section Chief of Infectious Diseases, Baylor College of Medicine, One Baylor Plaza - BCM285, Houston, TX 77030 (e-mail: tpg@bcm.edu).

Supported by the National Institutes of Health (Grant number R01MH085527; T.P.G.) and the facilities and resources of the Harris Health System and the Michael E. DeBakey VA Medical Center.

The authors have no conflicts of interest to disclose.

Received April 27, 2018

Accepted September 03, 2018

Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.