1507. High Patient Turnover in a Large Public HIV Clinic and its Association with Mortality
Session: Poster Abstract Session: HIV and Co-infections
Saturday, October 5, 2013
Room: The Moscone Center: Poster Hall C
Background: Engagement in HIV care is associated with better health outcomes. Our goal was to assess long-term follow-up of a well-defined HIV clinic cohort to assess gaps in care and patient turnover and their association with mortality.

Methods: All HIV-infected adults with an HIV clinic visit from July-December 2006 were included. We also included HIV-infected adults with clinic visits from 2007-10 who had HIV clinic visits from January 2004-June 2006 in order to capture out-of-care individuals during the inclusion timeframe.  Utilizing electronic health records we extracted demographics and data on visits, labs, and mortality.  Records were reviewed to assess reasons for gaps in care > 9 months and reasons for losses to follow-up (not seen in the last 9 months of 2010).

Results: 1,293 patients were included: 168 (13%) were female, 404 (31%) were Hispanic, 246 (19%) were Black, and 75% were men who have sex with other men. At baseline, the median CD4 count was 349 cells/ul (IQR 205 - 530); 55% had suppressed HIV viremia.  Median follow-up was 4.2 years (IQR 2.2 - 4.4); 450 individuals (35%) had 568 gaps in care.  Median duration of an initial gap was 423 days (IQR 309 - 767). The most common reasons for initial gaps included no documented reason (55%), incarceration (16%), getting care elsewhere (12%), and substance abuse and/or homelessness (6%).  At the end of follow-up 798 (62%) patients remained in care, 158 (12%) had transferred care, 135 (10%) had moved out of state, 96 (7%) had died, 73 (6%) were out of care, and 33 (3%) were incarcerated. During the four years of follow-up, 715 new patients entered care and remained in care in 2010. In multivariate logistic regression, factors associated with mortality included baseline CD4 count (OR 0.7 95%CI 0.6 – 0.8 per 100 cell increase), baseline suppressed viremia (OR 0.6 95%CI 0.4 - 0.99), age (OR 1.6 95%CI 1.2 – 2.0 per 10 year increase), IDU HIV-risk factor (OR 1.5 95%CI 0.9 – 2.4), and not having a gap in care (OR 3.1 95%CI 1.7 – 5.6).

Conclusion: There was an enormous amount of patient turnover in our public HIV clinic over 4 years of follow-up. Despite the lack of association between gaps in care and mortality, gaps in care and patient turnover contribute to chaotic HIV care and denigrate our ability to assess engagement in care in the U.S.

Edward Gardner, MD1, Margaret Mclees, MD1, Robert Beum, CCP1, Juanita Lovato2, Moises Maravi, BS, MSc1 and William Burman, MD3, (1)Denver Public Health, Denver, CO, (2)Public Health-TB Control Program, Denver Health Medical Center, Denver, CO, (3)Denver Health Medical Center, Denver, CO


E. Gardner, None

M. Mclees, None

R. Beum, None

J. Lovato, None

M. Maravi, None

W. Burman, None

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