Measuring retention in HIV care: The elusive gold standard

Michael J. Mugavero; Andrew O. Westfall; Anne Zinski; Jessica Davila; Mari Lynn Drainoni; Lytt I. Gardner; Jeanne C. Keruly; Faye Malitz; Gary Marks; Lisa Metsch; Tracey E. Wilson; Thomas P. Giordano; M. L. Drainoni; C. Ferreira; L. Koppelman; R. Lewis; M. McDoom; M. Naisteter; K. Osella; G. Ruiz; P. Skolnik; M. Sullivan; S. Gibbs-Cohen; E. Desrivieres; M. Frederick; K. Gravesande; S. Holman; H. Johnson; T. Taylor; S. Batey; S. Gaskin; M. Mugavero; J. Murphree; J. Raper; M. Saag; S. Thogaripally; J. Willig; A. Zinski; M. Arya; D. Bartholomew; T. Biggs; H. Budhwani; J. Davila; T. Giordano; N. Miertschin; S. Payne; W. Slaughter; M. Jenckes; J. Keruly; A. McCray; M. McGann; R. Moore; M. Otterbein; L. Zhou; C. Garzon; J. Jean-Simon; K. Mercogliano; L. Metsch; A. Rodriguez; G. Saint-Jean; M. Shika; L. Cheever; F. Malitz; R. Mills; J. Craw; L. Gardner; S. Girde; G. Marks; L. Bradley-Springer; M. Corwin

doi:10.1097/QAI.0b013e318273762f

Measuring retention in HIV care: The elusive gold standard

Michael J. Mugavero, Andrew O. Westfall, Anne Zinski, Jessica Davila, Mari Lynn Drainoni, Lytt I. Gardner, Jeanne C. Keruly, Faye Malitz, Gary Marks, Lisa Metsch, Tracey E. Wilson, Thomas P. Giordano, M. L. Drainoni, C. Ferreira, L. Koppelman, R. Lewis, M. McDoom, M. Naisteter, K. Osella, G. RuizP. Skolnik, M. Sullivan, S. Gibbs-Cohen, E. Desrivieres, M. Frederick, K. Gravesande, S. Holman, H. Johnson, T. Taylor, S. Batey, S. Gaskin, M. Mugavero, J. Murphree, J. Raper, M. Saag, S. Thogaripally, J. Willig, A. Zinski, M. Arya, D. Bartholomew, T. Biggs, H. Budhwani, J. Davila, T. Giordano, N. Miertschin, S. Payne, W. Slaughter, M. Jenckes, J. Keruly, A. McCray, M. McGann, R. Moore, M. Otterbein, L. Zhou, C. Garzon, J. Jean-Simon, K. Mercogliano, L. Metsch, A. Rodriguez, G. Saint-Jean, M. Shika, L. Cheever, F. Malitz, R. Mills, J. Craw, L. Gardner, S. Girde, G. Marks, L. Bradley-Springer, M. Corwin

School of Medicine

Research output: Contribution to journal › Article › peer-review

174 Scopus citations

Abstract

Background: Measuring retention in HIV primary care is complex, as care includes multiple visits scheduled at varying intervals over time. We evaluated 6 commonly used retention measures in predicting viral load (VL) suppression and the correlation among measures. Methods: Clinic-wide patient-level data from 6 academic HIV clinics were used for 12 months preceding implementation of the Centers for Disease Control and Prevention/Health Resources and Services Administration (CDC/HRSA) retention in care intervention. Six retention measures were calculated for each patient based on scheduled primary HIV provider visits: count and dichotomous missed visits, visit adherence, 6-month gap, 4-month visit constancy, and the HRSA HIV/AIDS Bureau (HRSA HAB) retention measure. Spearman correlation coefficients and separate unadjusted logistic regression models compared retention measures with one another and with 12-month VL suppression, respectively. The discriminatory capacity of each measure was assessed with the c-statistic. Results: Among 10,053 patients, 8235 (82%) had 12-month VL measures, with 6304 (77%) achieving suppression (VL <400 copies/mL). All 6 retention measures were significantly associated (P < 0.0001) with VL suppression (odds ratio; 95% CI, c-statistic): missed visit count (0.73; 0.71 to 0.75, 0.67), missed visit dichotomous (3.2; 2.8 to 3.6, 0.62), visit adherence (3.9; 3.5 to 4.3,0.69), gap (3.0; 2.6 to 3.3, 0.61), visit constancy (2.8; 2.5 to 3.0, 0.63), and HRSA HAB (3.8; 3.3 to 4.4, 0.59). Measures incorporating "no-show" visits were highly correlated (Spearman coefficient = 0.83-0.85), as were measures based solely on kept visits (Spearman coefficient = 0.72-0.77). Correlation coefficients were lower across these 2 groups ofmeasures (range = 0.16-0.57). Conclusions: Six retention measures displayed a wide range of correlation with one another, yet each measure had significant association and modest discrimination for VL suppression. These data suggest there is no clear gold standard and that selection of a retention measure may be tailored to context.

Original language	English (US)
Pages (from-to)	574-580
Number of pages	7
Journal	Journal of Acquired Immune Deficiency Syndromes
Volume	61
Issue number	5
DOIs	https://doi.org/10.1097/QAI.0b013e318273762f
State	Published - Dec 15 2012

Keywords

Adherence
Engagement in care
Retention in care
Viral load

ASJC Scopus subject areas

Infectious Diseases
Pharmacology (medical)

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10.1097/QAI.0b013e318273762f

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Mugavero, M. J., Westfall, A. O., Zinski, A., Davila, J., Drainoni, M. L., Gardner, L. I., Keruly, J. C., Malitz, F., Marks, G., Metsch, L., Wilson, T. E., Giordano, T. P., Drainoni, M. L., Ferreira, C., Koppelman, L., Lewis, R., McDoom, M., Naisteter, M., Osella, K., ... Corwin, M. (2012). Measuring retention in HIV care: The elusive gold standard. Journal of Acquired Immune Deficiency Syndromes, 61(5), 574-580. https://doi.org/10.1097/QAI.0b013e318273762f

Mugavero, MJ, Westfall, AO, Zinski, A, Davila, J, Drainoni, ML, Gardner, LI, Keruly, JC, Malitz, F, Marks, G, Metsch, L, Wilson, TE, Giordano, TP, Drainoni, ML, Ferreira, C, Koppelman, L, Lewis, R, McDoom, M, Naisteter, M, Osella, K, Ruiz, G, Skolnik, P, Sullivan, M, Gibbs-Cohen, S, Desrivieres, E, Frederick, M, Gravesande, K, Holman, S, Johnson, H, Taylor, T, Batey, S, Gaskin, S, Mugavero, M, Murphree, J, Raper, J, Saag, M, Thogaripally, S, Willig, J, Zinski, A, Arya, M, Bartholomew, D, Biggs, T, Budhwani, H, Davila, J, Giordano, T, Miertschin, N, Payne, S, Slaughter, W, Jenckes, M, Keruly, J, McCray, A, McGann, M, Moore, R, Otterbein, M, Zhou, L, Garzon, C, Jean-Simon, J, Mercogliano, K, Metsch, L, Rodriguez, A, Saint-Jean, G, Shika, M, Cheever, L, Malitz, F, Mills, R, Craw, J, Gardner, L, Girde, S, Marks, G, Bradley-Springer, L & Corwin, M 2012, 'Measuring retention in HIV care: The elusive gold standard', Journal of Acquired Immune Deficiency Syndromes, vol. 61, no. 5, pp. 574-580. https://doi.org/10.1097/QAI.0b013e318273762f

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title = "Measuring retention in HIV care: The elusive gold standard",

abstract = "Background: Measuring retention in HIV primary care is complex, as care includes multiple visits scheduled at varying intervals over time. We evaluated 6 commonly used retention measures in predicting viral load (VL) suppression and the correlation among measures. Methods: Clinic-wide patient-level data from 6 academic HIV clinics were used for 12 months preceding implementation of the Centers for Disease Control and Prevention/Health Resources and Services Administration (CDC/HRSA) retention in care intervention. Six retention measures were calculated for each patient based on scheduled primary HIV provider visits: count and dichotomous missed visits, visit adherence, 6-month gap, 4-month visit constancy, and the HRSA HIV/AIDS Bureau (HRSA HAB) retention measure. Spearman correlation coefficients and separate unadjusted logistic regression models compared retention measures with one another and with 12-month VL suppression, respectively. The discriminatory capacity of each measure was assessed with the c-statistic. Results: Among 10,053 patients, 8235 (82%) had 12-month VL measures, with 6304 (77%) achieving suppression (VL <400 copies/mL). All 6 retention measures were significantly associated (P < 0.0001) with VL suppression (odds ratio; 95% CI, c-statistic): missed visit count (0.73; 0.71 to 0.75, 0.67), missed visit dichotomous (3.2; 2.8 to 3.6, 0.62), visit adherence (3.9; 3.5 to 4.3,0.69), gap (3.0; 2.6 to 3.3, 0.61), visit constancy (2.8; 2.5 to 3.0, 0.63), and HRSA HAB (3.8; 3.3 to 4.4, 0.59). Measures incorporating {"}no-show{"} visits were highly correlated (Spearman coefficient = 0.83-0.85), as were measures based solely on kept visits (Spearman coefficient = 0.72-0.77). Correlation coefficients were lower across these 2 groups ofmeasures (range = 0.16-0.57). Conclusions: Six retention measures displayed a wide range of correlation with one another, yet each measure had significant association and modest discrimination for VL suppression. These data suggest there is no clear gold standard and that selection of a retention measure may be tailored to context.",

keywords = "Adherence, Engagement in care, Retention in care, Viral load",

author = "Mugavero, {Michael J.} and Westfall, {Andrew O.} and Anne Zinski and Jessica Davila and Drainoni, {Mari Lynn} and Gardner, {Lytt I.} and Keruly, {Jeanne C.} and Faye Malitz and Gary Marks and Lisa Metsch and Wilson, {Tracey E.} and Giordano, {Thomas P.} and Drainoni, {M. L.} and C. Ferreira and L. Koppelman and R. Lewis and M. McDoom and M. Naisteter and K. Osella and G. Ruiz and P. Skolnik and M. Sullivan and S. Gibbs-Cohen and E. Desrivieres and M. Frederick and K. Gravesande and S. Holman and H. Johnson and T. Taylor and S. Batey and S. Gaskin and M. Mugavero and J. Murphree and J. Raper and M. Saag and S. Thogaripally and J. Willig and A. Zinski and M. Arya and D. Bartholomew and T. Biggs and H. Budhwani and J. Davila and T. Giordano and N. Miertschin and S. Payne and W. Slaughter and M. Jenckes and J. Keruly and A. McCray and M. McGann and R. Moore and M. Otterbein and L. Zhou and C. Garzon and J. Jean-Simon and K. Mercogliano and L. Metsch and A. Rodriguez and G. Saint-Jean and M. Shika and L. Cheever and F. Malitz and R. Mills and J. Craw and L. Gardner and S. Girde and G. Marks and L. Bradley-Springer and M. Corwin",

year = "2012",

month = dec,

day = "15",

doi = "10.1097/QAI.0b013e318273762f",

language = "English (US)",

volume = "61",

pages = "574--580",

journal = "Journal of Acquired Immune Deficiency Syndromes",

issn = "1525-4135",

publisher = "Lippincott Williams and Wilkins",

number = "5",

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TY - JOUR

T1 - Measuring retention in HIV care

T2 - The elusive gold standard

AU - Mugavero, Michael J.

AU - Westfall, Andrew O.

AU - Zinski, Anne

AU - Davila, Jessica

AU - Drainoni, Mari Lynn

AU - Gardner, Lytt I.

AU - Keruly, Jeanne C.

AU - Malitz, Faye

AU - Marks, Gary

AU - Metsch, Lisa

AU - Wilson, Tracey E.

AU - Giordano, Thomas P.

AU - Drainoni, M. L.

AU - Ferreira, C.

AU - Koppelman, L.

AU - Lewis, R.

AU - McDoom, M.

AU - Naisteter, M.

AU - Osella, K.

AU - Ruiz, G.

AU - Skolnik, P.

AU - Sullivan, M.

AU - Gibbs-Cohen, S.

AU - Desrivieres, E.

AU - Frederick, M.

AU - Gravesande, K.

AU - Holman, S.

AU - Johnson, H.

AU - Taylor, T.

AU - Batey, S.

AU - Gaskin, S.

AU - Mugavero, M.

AU - Murphree, J.

AU - Raper, J.

AU - Saag, M.

AU - Thogaripally, S.

AU - Willig, J.

AU - Zinski, A.

AU - Arya, M.

AU - Bartholomew, D.

AU - Biggs, T.

AU - Budhwani, H.

AU - Davila, J.

AU - Giordano, T.

AU - Miertschin, N.

AU - Payne, S.

AU - Slaughter, W.

AU - Jenckes, M.

AU - Keruly, J.

AU - McCray, A.

AU - McGann, M.

AU - Moore, R.

AU - Otterbein, M.

AU - Zhou, L.

AU - Garzon, C.

AU - Jean-Simon, J.

AU - Mercogliano, K.

AU - Metsch, L.

AU - Rodriguez, A.

AU - Saint-Jean, G.

AU - Shika, M.

AU - Cheever, L.

AU - Malitz, F.

AU - Mills, R.

AU - Craw, J.

AU - Gardner, L.

AU - Girde, S.

AU - Marks, G.

AU - Bradley-Springer, L.

AU - Corwin, M.

PY - 2012/12/15

Y1 - 2012/12/15

N2 - Background: Measuring retention in HIV primary care is complex, as care includes multiple visits scheduled at varying intervals over time. We evaluated 6 commonly used retention measures in predicting viral load (VL) suppression and the correlation among measures. Methods: Clinic-wide patient-level data from 6 academic HIV clinics were used for 12 months preceding implementation of the Centers for Disease Control and Prevention/Health Resources and Services Administration (CDC/HRSA) retention in care intervention. Six retention measures were calculated for each patient based on scheduled primary HIV provider visits: count and dichotomous missed visits, visit adherence, 6-month gap, 4-month visit constancy, and the HRSA HIV/AIDS Bureau (HRSA HAB) retention measure. Spearman correlation coefficients and separate unadjusted logistic regression models compared retention measures with one another and with 12-month VL suppression, respectively. The discriminatory capacity of each measure was assessed with the c-statistic. Results: Among 10,053 patients, 8235 (82%) had 12-month VL measures, with 6304 (77%) achieving suppression (VL <400 copies/mL). All 6 retention measures were significantly associated (P < 0.0001) with VL suppression (odds ratio; 95% CI, c-statistic): missed visit count (0.73; 0.71 to 0.75, 0.67), missed visit dichotomous (3.2; 2.8 to 3.6, 0.62), visit adherence (3.9; 3.5 to 4.3,0.69), gap (3.0; 2.6 to 3.3, 0.61), visit constancy (2.8; 2.5 to 3.0, 0.63), and HRSA HAB (3.8; 3.3 to 4.4, 0.59). Measures incorporating "no-show" visits were highly correlated (Spearman coefficient = 0.83-0.85), as were measures based solely on kept visits (Spearman coefficient = 0.72-0.77). Correlation coefficients were lower across these 2 groups ofmeasures (range = 0.16-0.57). Conclusions: Six retention measures displayed a wide range of correlation with one another, yet each measure had significant association and modest discrimination for VL suppression. These data suggest there is no clear gold standard and that selection of a retention measure may be tailored to context.

AB - Background: Measuring retention in HIV primary care is complex, as care includes multiple visits scheduled at varying intervals over time. We evaluated 6 commonly used retention measures in predicting viral load (VL) suppression and the correlation among measures. Methods: Clinic-wide patient-level data from 6 academic HIV clinics were used for 12 months preceding implementation of the Centers for Disease Control and Prevention/Health Resources and Services Administration (CDC/HRSA) retention in care intervention. Six retention measures were calculated for each patient based on scheduled primary HIV provider visits: count and dichotomous missed visits, visit adherence, 6-month gap, 4-month visit constancy, and the HRSA HIV/AIDS Bureau (HRSA HAB) retention measure. Spearman correlation coefficients and separate unadjusted logistic regression models compared retention measures with one another and with 12-month VL suppression, respectively. The discriminatory capacity of each measure was assessed with the c-statistic. Results: Among 10,053 patients, 8235 (82%) had 12-month VL measures, with 6304 (77%) achieving suppression (VL <400 copies/mL). All 6 retention measures were significantly associated (P < 0.0001) with VL suppression (odds ratio; 95% CI, c-statistic): missed visit count (0.73; 0.71 to 0.75, 0.67), missed visit dichotomous (3.2; 2.8 to 3.6, 0.62), visit adherence (3.9; 3.5 to 4.3,0.69), gap (3.0; 2.6 to 3.3, 0.61), visit constancy (2.8; 2.5 to 3.0, 0.63), and HRSA HAB (3.8; 3.3 to 4.4, 0.59). Measures incorporating "no-show" visits were highly correlated (Spearman coefficient = 0.83-0.85), as were measures based solely on kept visits (Spearman coefficient = 0.72-0.77). Correlation coefficients were lower across these 2 groups ofmeasures (range = 0.16-0.57). Conclusions: Six retention measures displayed a wide range of correlation with one another, yet each measure had significant association and modest discrimination for VL suppression. These data suggest there is no clear gold standard and that selection of a retention measure may be tailored to context.

KW - Adherence

KW - Engagement in care

KW - Retention in care

KW - Viral load

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Measuring retention in HIV care: The elusive gold standard

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