481. Pill Burden, Drug Use, Mental Illness, and Imprisonment and the Impact on Retention Rates for HIV/Hepatitis C Co-Infected Patients in South Carolina
Session: Poster Abstract Session: HIV Care Continuum
Thursday, October 27, 2016
Room: Poster Hall

Background: For HIV patients, poor retention has been linked to poor clinical outcomes. The same may be assumed for those patients co-infected with Hepatitis C (HCV), although little has been reported. In this study we evaluate factors thought to negatively impact retention of co-infected patients in an urban clinic in South Carolina, specifically pill burden, comorbidities, mental illness, imprisonment, and intravenous drug usage (IVDU).

Methods: A retrospective cohort study was used to evaluate patients in our clinic whose initial visit was between 2006 and 2012. Patients seen prior to 2006 who were lost to follow up for more than 2 years then re-established care were also included. Retention was defined as at least 2 visits, divided by 90 days within a 1 year period.  Data from initial and subsequent visits was collected for three years.

Results:  Within our cohort, 82% were male, 61% were African American, and the mean age was 55.  Increased numbers of pills, medications, and comorbidities trended towards decreased retention.  More than 50% of this population also had IVDU and mental illness.  Retention waned over time but did not vary significantly by patient risk factor.

Retention at 1 Year with Regards to Medications and Comorbidities

Retained*

Not Retained*

Number of Pills

9.3 [7-11.6]

12.6 [6-19.1]

Number of Medications

6.6 [5.2-8.0]

7.5 [4.4-11.0]

Number of Comorbidities

4.9 [4.3-5.6]

6.1 [4.9-7.4]

* Mean[95% CI]

Retention Years 1-3 with Regards to Specific Patient Factors

Population [n (%)]

Year 1

Year 2

Year 3

IVDU

27(55%)

19(70%)

17(63%)

10(37%)

Mental illness

26(53%)

18(69%)

17(65%)

11(42%)

Imprisonment

16(33%)

12(75%)

9(56%)

6(38%)

Total Population

49

35(71%)

28(57%)

18(37%)

Conclusion: Overall this population had declining retention over time, especially at three years.  While IVDU, mental illness, and imprisonment seem to be an impediment to retention in care, the data did not demonstrate a dramatic difference from the total population.  Patients who were not retained trended towards increased burden of pill count, medications, and comorbidities, thus consolidation of therapy may improve retention.  

Amanda Schnee, MD1, Madelyne Bean, PharmD2, Cassandra Salgado, MD, MS2 and Lauren Richey, MD, MPH2, (1)Medical University of South Carolina, Charleston, SC, (2)Infectious Diseases, Medical University of South Carolina, Charleston, SC

Disclosures:

A. Schnee, None

M. Bean, None

C. Salgado, None

L. Richey, None

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