483. Behavioral and Clinical Predictors of Poor Engagement in HIV Care among Injection Drug Users
Session: Poster Abstract Session: HIV Primary Care
Friday, October 21, 2011
Room: Poster Hall B1
Background: Poor engagement in HIV care is associated with increased mortality and decreased odds of virologic suppression in response to antiretroviral therapy.  We investigated whether injection drug users’ (IDUs) self report of care engagement accurately reflects HIV clinic attendance.

Methods: We prospectively followed 538 HIV-infected IDUs from 2005 and 2010 as part of a community-based, longitudinal cohort study in Baltimore, MD.  Every six months, participants were asked whether they were currently engaged in regular clinical care for HIV. With participants’ consent, we obtained records from the site where they receive care to confirm clinic attendance and collect laboratory and clinical data.  Self-report of being currently engaged in care was compared to actual clinic attendance during the 12 month period prior to each study visit.  Logistic regression with generalized estimating equations was used to identify demographic, clinical and behavioral factors independently associated with clinic non-attendance despite self-report of being in care.

Results:  IDUs reported current engagement in HIV care at 96% of study visits.  Based on review of medical records, however, only 67% of IDUs attended the minimum of 1 clinic visit per six months over the prior year, while 33% did not.  The odds of failing to attend recommended HIV care visits despite self-report of regular care were greater for IDUs who were female (OR 1.4; 95% CI 1.0-1.8), injected drugs daily (OR 1.7; 1.2-2.4), and were recently incarcerated (OR 1.9; 1.3-2.9). IDUs who reported seeing the same provider at greater than 90% of clinic visits were less likely to have poor engagement in care (OR 0.5; 0.3-0.8).  Failing to attend at least 2 semiannual HIV care visits in the past year was associated with nearly 30% decreased odds of achieving an undetectable HIV RNA (OR 0.7; 0.6-0.9).

Conclusion:  We observed significant discordance between IDUs’ perceptions of being engaged in HIV care and actual attendance at a minimum number of HIV care visits, which was associated with decreased likelihood of HIV suppression.  Daily injecting, recent incarceration and female gender are markers of IDUs who are likely to fail to attend care visits, while continuity of care provider appears to have a protective effect.

Subject Category: H. HIV/AIDS and other retroviruses

Ryan Westergaard, MD, MPH1, Shruti Mehta, PhD, MPH2, Jacquie Astemborski, MS2, Richard Moore, MD, MHS3 and Gregory Kirk, MD, MPH, PhD2, (1)Infectious Diseases, Johns Hopkins University, Baltimore, MD, (2)Bloomberg Sch. of Publ. Health, Johns Hopkins Univ., Baltimore, MD, (3)Johns Hopkins University School of Medicine, Baltimore, MD


R. Westergaard, None

S. Mehta, None

J. Astemborski, None

R. Moore, Glaxo Smith Kline: Grant Investigator, Research grant

G. Kirk, None

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