Geographic variations in retention in care among HIV-infected adults in the United States

North American AIDS Cohort Collaboration on Research and Design (NA-ACCORD)

Research output: Contribution to journalArticle

Abstract

Objective. To understand geographic variations in clinical retention, a central component of the HIV care continuum and key to improving individual- and population-level HIV outcomes. Design. We evaluated retention by US region in a retrospective observational study. Methods. Adults receiving care from 2000-2010 in 12 clinical cohorts of the North American AIDS Cohort Collaboration on Research and Design (NA-ACCORD) contributed data. Individuals were assigned to Centers for Disease Control and Prevention (CDC)-defined regions by residential data (10 cohorts) and clinic location as proxy (2 cohorts). Retention was ≥2 primary HIV outpatient visits within a calendar year, >90 days apart. Trends and regional differences were analyzed using modified Poisson regression with clustering, adjusting for time in care, age, sex, race/ethnicity, and HIV risk, and stratified by baseline CD4+ count. Results. Among 78,993 adults with 444,212 person-years of follow-up, median time in care was 7 years (Interquartile Range: 4-9). Retention increased from 2000 to 2010: from 73% (5,000/6,875) to 85% (7,189/8,462) in the Northeast, 75% (1,778/2,356) to 87% (1,630/1,880) in the Midwest, 68% (8,451/12,417) to 80% (9,892/12,304) in the South, and 68% (5,147/7,520) to 72% (6,401/8,895) in the West. In adjusted analyses, retention improved over time in all regions (p

Original languageEnglish (US)
Article numbere0146119
JournalPLoS One
Volume11
Issue number1
DOIs
StatePublished - Jan 11 2016

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geographical variation
HIV
Disease control
Centers for Disease Control and Prevention
observational studies
nationalities and ethnic groups
HIV-2
Continuity of Patient Care
Proxy
Centers for Disease Control and Prevention (U.S.)
CD4 Lymphocyte Count
Observational Studies
Cluster Analysis
gender
Acquired Immunodeficiency Syndrome
Research Design
Outpatients
Retrospective Studies
Population
methodology

ASJC Scopus subject areas

  • Agricultural and Biological Sciences(all)
  • Biochemistry, Genetics and Molecular Biology(all)
  • Medicine(all)

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North American AIDS Cohort Collaboration on Research and Design (NA-ACCORD) (2016). Geographic variations in retention in care among HIV-infected adults in the United States. PLoS One, 11(1), [e0146119]. https://doi.org/10.1371/journal.pone.0146119

Geographic variations in retention in care among HIV-infected adults in the United States. / North American AIDS Cohort Collaboration on Research and Design (NA-ACCORD).

In: PLoS One, Vol. 11, No. 1, e0146119, 11.01.2016.

Research output: Contribution to journalArticle

North American AIDS Cohort Collaboration on Research and Design (NA-ACCORD) 2016, 'Geographic variations in retention in care among HIV-infected adults in the United States', PLoS One, vol. 11, no. 1, e0146119. https://doi.org/10.1371/journal.pone.0146119
North American AIDS Cohort Collaboration on Research and Design (NA-ACCORD). Geographic variations in retention in care among HIV-infected adults in the United States. PLoS One. 2016 Jan 11;11(1). e0146119. https://doi.org/10.1371/journal.pone.0146119
North American AIDS Cohort Collaboration on Research and Design (NA-ACCORD). / Geographic variations in retention in care among HIV-infected adults in the United States. In: PLoS One. 2016 ; Vol. 11, No. 1.
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abstract = "Objective. To understand geographic variations in clinical retention, a central component of the HIV care continuum and key to improving individual- and population-level HIV outcomes. Design. We evaluated retention by US region in a retrospective observational study. Methods. Adults receiving care from 2000-2010 in 12 clinical cohorts of the North American AIDS Cohort Collaboration on Research and Design (NA-ACCORD) contributed data. Individuals were assigned to Centers for Disease Control and Prevention (CDC)-defined regions by residential data (10 cohorts) and clinic location as proxy (2 cohorts). Retention was ≥2 primary HIV outpatient visits within a calendar year, >90 days apart. Trends and regional differences were analyzed using modified Poisson regression with clustering, adjusting for time in care, age, sex, race/ethnicity, and HIV risk, and stratified by baseline CD4+ count. Results. Among 78,993 adults with 444,212 person-years of follow-up, median time in care was 7 years (Interquartile Range: 4-9). Retention increased from 2000 to 2010: from 73{\%} (5,000/6,875) to 85{\%} (7,189/8,462) in the Northeast, 75{\%} (1,778/2,356) to 87{\%} (1,630/1,880) in the Midwest, 68{\%} (8,451/12,417) to 80{\%} (9,892/12,304) in the South, and 68{\%} (5,147/7,520) to 72{\%} (6,401/8,895) in the West. In adjusted analyses, retention improved over time in all regions (p",
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AU - Abraham, Alison Gump

AU - Napravnik, Sonia

AU - Samji, Hasina

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AU - Turner, Megan

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N2 - Objective. To understand geographic variations in clinical retention, a central component of the HIV care continuum and key to improving individual- and population-level HIV outcomes. Design. We evaluated retention by US region in a retrospective observational study. Methods. Adults receiving care from 2000-2010 in 12 clinical cohorts of the North American AIDS Cohort Collaboration on Research and Design (NA-ACCORD) contributed data. Individuals were assigned to Centers for Disease Control and Prevention (CDC)-defined regions by residential data (10 cohorts) and clinic location as proxy (2 cohorts). Retention was ≥2 primary HIV outpatient visits within a calendar year, >90 days apart. Trends and regional differences were analyzed using modified Poisson regression with clustering, adjusting for time in care, age, sex, race/ethnicity, and HIV risk, and stratified by baseline CD4+ count. Results. Among 78,993 adults with 444,212 person-years of follow-up, median time in care was 7 years (Interquartile Range: 4-9). Retention increased from 2000 to 2010: from 73% (5,000/6,875) to 85% (7,189/8,462) in the Northeast, 75% (1,778/2,356) to 87% (1,630/1,880) in the Midwest, 68% (8,451/12,417) to 80% (9,892/12,304) in the South, and 68% (5,147/7,520) to 72% (6,401/8,895) in the West. In adjusted analyses, retention improved over time in all regions (p

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