1770. The Association of Unmet Needs with Subsequent Retention in Care and HIV Suppression Among Hospitalized Patients with HIV Who Are Out of Care
Session: Oral Abstract Session: Optimizing HIV Treatment
Saturday, October 6, 2018: 11:30 AM
Room: S 156

Background: Unmet needs among hospitalized patients with HIV may prevent engagement in HIV care leading to worse clinical outcomes. Our aim was to examine the role of unmet subsistence needs (e.g. housing, transportation, food) and medical needs (e.g. mental health, substance abuse treatment) as barriers for retention in HIV care and viral load (VL) suppression.

Methods: We utilized data from the Mentor Approach for Promoting Patients’ Self-Care intervention study, the enrolled hospitalized HIV-patients at a large publicly funded hospital between 2010 and 2013, who were out-of-care. We examined the effect of unmet needs on retention in HIV care (attended HIV appointments within 0-30 days and 30-180 days) and viral load suppression, six months after discharge.

Results: 417 participants were enrolled, 78% reported having ≥1 unmet need at baseline, most commonly dental care (55%), financial (43%), or housing needs (34%). Participants with unmet needs at baseline, compared to those with no needs, were more likely to be African-American, have an existing HIV diagnosis, and be uninsured. Among participants who completed a baseline and 3-month survey (n=320), 45% reported a need for dental care, 42% reported financial needs, and 32% reported housing needs that were unmet at either time point (Fig.1). Having a dental care need at baseline that was met was significantly associated with higher odds of VL improvements at 6-month follow up (OR: 2.2; 95% CI: 1.04-4.50, p=0.03) and higher odds for retention in care (OR: 2.06; 95% CI: 1.05-4.07, p=0.04). An unmet need for transportation was associated with lower odds of retention in care (OR: 0.5; 95% CI:0.34-0.94, p=0.03), even after adjusting for other factors. Compared to participants with no need, those who reported ≥3 unmet subsistence needs were less likely to demonstrate viral load improvement (OR: 0.51; 95% CI:0.28-0.92; p=0.03) and to be retained in care (OR: 0.52; 95% CI:0.28-0.95; p=0.03).

Conclusion: An important and novel finding in our study is that the number of unmet subsistence needs had a significant effect on retention in care and VL suppression. Broader access to programs that can assist in meeting subsistence needs among hospitalized patients could have significant individual and public health benefits. 

Figure 1. Percentage of participants with a specific need that was met or unmet at baseline (n=417), top bar, and the percentage of participants with a specific need that was met at both time points or unmet at either time point at 3-month follow-up, bottom bar (n = 320).

                                                     

Dima Dandachi, M.D.1, Sarah May, M.S.2, Jessica Davila, Ph.D.2, Jeffrey Cully, Ph.D.3, K Rivet Amico, Ph.D.4, Michael A. Kallen, Ph.D., M.P.H.5 and Thomas P. Giordano, M.D., M.P.H., FIDSA1, (1)Department of Medicine, Section of Infectious Diseases, Baylor College of Medicine, Houston, TX, (2)Center for Innovations in Quality, Effectiveness, and Safety, Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX, (3)Department of Medicine, Section of Health Services Research, Baylor College of Medicine, Houston, TX, (4)School of Public Health, University of Michigan, Ann Arbor, MI, (5)Department of General Internal Medicine, The University of Texas M.D. Anderson Cancer Center, Houston, TX, USA, Houston, TX

Disclosures:

D. Dandachi, None

S. May, None

J. Davila, None

J. Cully, None

K. R. Amico, None

M. A. Kallen, None

T. P. Giordano, None

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