484. HIV Quality Metrics (QM): Association between Retention in Care and Maximal Viral Control
Session: Poster Abstract Session: HIV Primary Care
Friday, October 21, 2011
Room: Poster Hall B1
  • IDSA Poster 10032011 v.8.2.pdf (393.8 kB)
  • Background:

    HIV Quality Metrics (QM), as endorsed by National Quality Forum, are used to assess the success of HIV care and are critical to monitoring US National HIV/AIDS Strategy (NHAS) progress.  We report the relationship between two QM: 1) retention in care (percentage of patients with ≥2 visits to HIV or primary care (PC)/year ≥60 days apart of HIV+ patients in care) and 2) HIV viral load (VL) maximal control.


    We identified all HIV+ patients (“All”) in Kaiser Permanente (9 states plus DC) during years 2007 (N=17,420), 2008 (N=19,025) and 2009 (N=19,550) (HI and CO not included in 2007).  From those, we identified “In Care” (HIV+ by July 1 with ≥8 months' membership in that year) by year: N=13,896, 15,114, 15,783, respectively.  Among those we identified patients “Compliant” with care retention QM: N=10,666, 11,979, 12,284, respectively.  We measured for each patient the number of visits/year and their lowest VL in each year.  For each patient group (All, In Care, Compliant) we determined the % with VL <75 copies/mL (BLQ) at least once during the year (no VL measured = not ever BLQ), and the mean lowest VL.  We compared %BLQ within year and between years for all three groups. Finally, we employed mixed logistic regression (with clustering by region and adjusting for age and gender) by year to determine if the number of office visits was associated with odds BLQ. 


    The percent of All patients on antiretroviral therapy increased significantly by year: 72.1%, 74.5%, and 77.4%, respectively (p<0.001).  All cohorts had >60% BLQ at any time.


    Mean VL for both In Care and Compliant were significantly less than All by year (p<0.001), see figure.  The %BLQ was significantly increased across and within groups over time and by year (all p<0.001), see figure.  In multivariate adjusted analysis, for each additional visit per year, the adjusted odds of achieving BLQ ever in the year increased from 20.5% in 2007 (95% CI: 18.9-22.1%), to 28.7% in 2008 (26.7-30.8%), and 27.2% in 2009 (25.2-29.2%).


    In our population, the likelihood of achieving BLQ increased with higher number of visits, and rose to >80% in 2008 and 2009 among patients with 2+ visits annually.  As maximal viral control is a goal of NHAS, increasing retention in care is essential.


    Subject Category: H. HIV/AIDS and other retroviruses

    Michael Horberg, MD MAS1,2,3,4, Leo Hurley, MPH3, William Towner, MD5, Rebecca Gambatese, MPH6, Daniel Klein, MD7, Diana Antoniskis, MD8, Winkler Weinberg, MD9, Peter Kadlecik, MD10, Miguel Mogyoros, MD11,12, Drew Kovach, MD13, Carol Remmers, PhD6, Michael J. Silverberg, PhD, MPH1, Charles Quesenberry Jr.1 and Michael Johnson, PhD6, (1)Division of Research, Kaiser Permanente, Oakland, CA, (2)Kaiser Permanente, Oakland, CA, (3)Kaiser Permanente Medical Care Program, Oakland, CA, (4)Mid-Atlantic Permanente Research Institute, Mid-Atlantic Permanente Medical Group, Rockville, MD, (5)Infectious Disease, Kaiser Permanente Medical Center, Los Angeles, CA, (6)UCDA, Kaiser Permanente, Oakland, CA, (7)Kaiser Permanente, Hayward, CA, (8)Kaiser Permanente, Portland, OR, (9)Kaiser Permanente, Atlanta, GA, (10)Infectious Disease, Mid-Atlantic Permanente Medical Group, Largo, MD, (11)Kaiser Permanente, Denver, CO, (12)Kaiser Permanente Healthplan of Colorado, Denver, CO, (13)Kaiser Permanente, Honolulu, HI


    M. Horberg, None

    L. Hurley, None

    W. Towner, Pfizer: Grant Investigator and Investigator, Research grant and Research support
    Gilead: Investigator, Research support
    Tibotec: Investigator, Research support
    Merck: Grant Investigator and Investigator, Research grant and Research support

    R. Gambatese, None

    D. Klein, None

    D. Antoniskis, None

    W. Weinberg, None

    P. Kadlecik, None

    M. Mogyoros, None

    D. Kovach, None

    C. Remmers, None

    M. J. Silverberg, None

    C. Quesenberry Jr., None

    M. Johnson, None

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