406. Long-Term Retention in HIV Care: From the “Cascade” of Care to the “Cycle” of Care
Session: Poster Abstract Session: HIV Engagement in Care and the Care Cascade
Thursday, October 8, 2015
Room: Poster Hall
Posters
  • LongTermRetentioninHVCare_DH.png (858.2 kB)
  • Background: The current “cascade” of HIV care is a linear model that considers retention as a discrete event in the continuum of HIV care. We believe that this model may not be adequate for long-term evaluation of retention in care. This study describes long-term retention in care in a public referral hospital in Peru.

    Methods: We used data from a retrospective cohort of HIV-infected adults enrolled in the National HIV Control Program (NHCP) between 2006 and 2012. We described the proportion of “retained”, “non-retained” and “recovered” patients every calendar year after their year of NHCP entry until death, transfer or the end of 2013. Based on a previous study, we used the Health Resources and Services Administration HIV/AIDS Bureau measure, which defines “retained” patients as those having ≥2 HIV care visits in a year, >90 days apart. Only “retained” patients were included in subsequent year denominator for retention assessment. We defined “recovered” patients as those who were declared as “non-retained” during follow-up, but return to care in a subsequent year evaluation.

    Results: We included 3,054 patient records. After 1-year of NHCP entry between 53.0 to 57.4% of patients were retained in care and 30.8 to 37.8% were non-retained. In general, half of patients were retained in care every year after NHCP entry; and only 10% of patients were retained after 7 year in the NHCP. Mortality was higher during the first year of follow-up (6.8 to 10.9%) and declined thereafter. Number of retained patients declined sharply during first 3 years after NHCP enrollment (25 to 30%); meanwhile the amount of recovered patients increased steadily (3.3 to 6.8% after 2 year of follow-up; 22.5-37.8% after 4 years of follow-up) and became almost 50% after 7 years of NCHP entry.

    Conclusion: The “cascade” model of care fails to consider the dynamic nature of retention, especially during long-term follow-up. A high proportion of patients “cycle” between attrition and re-engagement in care. Further studies need to better characterize these patients and determine conditions under which they return to care.

    Daniel Hoces, MD1, Elsa González, MD2, Fernando Mejía, MD2, Juan Echevarría, MD2, Eduardo Gotuzzo, MD, FIDSA2 and Carlos Seas, MD, FIDSA2, (1)Instituto De Medicina Tropical Alexander Von Humboldt, Universidad Peruana Cayetano Heredia, Lima, Peru, (2)Instituto de Medicina Tropical Alexander von Humboldt, Universidad Peruana Cayetano Heredia, Lima, Peru

    Disclosures:

    D. Hoces, None

    E. González, None

    F. Mejía, None

    J. Echevarría, None

    E. Gotuzzo, None

    C. Seas, None

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