482. Retention in HIV Care in an Era of Highly Active Anti-retroviral Therapy for all HIV-1 infected Individuals
Session: Poster Abstract Session: HIV Care Continuum
Thursday, October 27, 2016
Room: Poster Hall
Posters
  • IDSA poster PDF.pdf (524.1 kB)
  • Background:

    Retention in HIV care is essential to meet targets outlined in the UNAIDS 90-90-90 plan. In an era of ART for all HIV-1 infected patients, our primary aim was to describe prevalence and characteristics of patients disengaged from care at an urban ambulatory HIV clinic. A secondary aim was to determine factors associated with non-engagement in care.

    Methods:

    We conducted a nested case-control study. All patients who disengaged from care (defined as loss to follow up for at least one year) from 2007 to 2014 inclusive were identified. Patient records were reviewed to collect demographics. Cases were matched for most recent year of attendance and HIV-1 positive status to controls in a 1:4 ratio. Statistical analysis was performed using SPSS v.23.

    Results:

    250 cases were matched to 1000 controls in a 1:4 ratio. 250/2289 (10.9%) of patients attending our HIV clinic disengaged from care from 2007 - 2014. 7 (2.8%) patients died over this period. 153 (61.2%) were male. 126 (50.4%) were heterosexual, 81 (32.4%) were MSM and 40 (16%) were IDU. 87 (34.8%) were Irish and 90 (36%) were from Sub-Saharan Africa. 88.4% of the heterosexual risk group were non-Irish. 59 (23.6%) patients had a CD4 count of <350 at the time of disengagement. 140 (56%) patients were taking ART and only 59 (42%) of these patients had a suppressed HIV-1 viral load at time of disengagement.

    On univariate analysis, those with heterosexual risk were more likely to disengage from care (50.4% vs, 33.7%, p: <0.001). Those who disengaged were younger with a mean age of 39 (p:<0.001) Non-Irish were more likely to disengage from care (65.2% vs 44.6%, p: <0.001). A higher proportion of patients who disengaged from care had not been receiving ART and did not have a suppressed HIV-1 viral load (p:<0.001).

    On multivariable analysis, Irish patients were less likely to disengage from HIV care (OR: 0.567, CI: 0.397 – 0.811, p: 0.002). Those with a suppressed HIV-1 viral load were less likely to disengage from HIV care (OR: 0.191, CI: 0.128-0.284, p:<0.001).

    Conclusion:

    From 2007 to 2014, 89% of those who attended our HIV clinic have retained in care. We have identified patients factors associated with non-engagement in HIV care in our cohort. A semi-structured patient interview will soon take place to gain a better understanding of patient factors associated with failure to retain in care.

    Sarah O'connell, MB MRCPI, Anna O'rourke, MB MRCPI, Eileen Sweeney, MB MRCPI, Almida Lynam, MB MRCPI, Corinna Sadlier, MD and Colm Bergin, MD, FRCPI, Genito-Urinary Medicine and Infectious Diseases, St James's Hospital, Dublin 8, Ireland

    Disclosures:

    S. O'connell, None

    A. O'rourke, None

    E. Sweeney, None

    A. Lynam, None

    C. Sadlier, None

    C. Bergin, None

    See more of: HIV Care Continuum
    See more of: Poster Abstract Session

    Findings in the abstracts are embargoed until 12:01 a.m. CDT, Wednesday Oct. 26th with the exception of research findings presented at the IDWeek press conferences.