High retention in HIV care at a tertiary care centre in Toronto,Canada* |
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| Authors: | Leah Szadkowski Sharon Walmsley Ann N. Burchell Evan Collins Sean B. Rourke Janet Raboud |
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| Affiliation: | 1. Toronto General Hospital Research Institute, University Health Network, Toronto, Canadaleah.szadkowski@uhnresearch.ca;3. Toronto General Hospital Research Institute, University Health Network, Toronto, Canada;4. Division of Infectious Diseases, University Health Network, Toronto, Canada;5. Faculty of Medicine, University of Toronto, Toronto, Canada;6. Centre for Urban Health Solutions, Keenan Research Centre, Li Ka Shing Knowledge Institute, St.?Michael’s Hospital, Toronto, Canada;7. Department of Family and Community Medicine, St.?Michael’s Hospital, Toronto, Canada;8. Dalla Lana School of Public Health, University of Toronto, Toronto, Canada;9. Division of Infectious Diseases, University Health Network, Toronto, Canada;10. Department of Psychiatry, University of Toronto, Toronto, Canada;11. Ontario HIV Treatment Network, Toronto, Canada |
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| Abstract: | Poor retention in HIV care is associated with poor clinical outcomes and mortality. Previous studies of predictors of poor retention have been conducted with a wide variety of populations, using different measures of retention, and occasionally have conflicting results. We studied demographic and psychosocial factors associated with inter-visit interval length in a setting of universal health care and modern cART. Patients attending ≥2 appointments with an HIV specialist at the Toronto General Hospital Immunodeficiency Clinic from 2004 to 2013 were studied. A sub-analysis included psychosocial measures from annual questionnaires for Ontario HIV Treatment Network Cohort Study (OCS) participants. Median inter-visit interval and constancy (percentage of 4-month intervals with ≥1 visit) were calculated by patient. Multivariable generalized estimating equation models identified factors associated with inter-visit interval length and intervals ≥12 months. 1591 patients were included. 615 patients completed an OCS questionnaire and were more likely to be older white MSM from Canada with a viral load (VL) <50 copies/ml. The median (IQR) of patients’ median inter-visit intervals was 3.15 (2.78, 3.84) months and median (IQR) constancy was 90% (71%, 100%). Two percent of inter-visit intervals were ≥12 months and 25% of patients had ≥1 interval ≥12 months. Longer inter-visit intervals were associated with younger age, white race, earlier calendar year, longer duration of HIV, VL < 50 copies/mL and higher CD4 counts. Patients who were younger, white, had injection drug use as a risk factor, had a longer duration of HIV, and had VL ≥50 copies/mL were more likely to have an inter-visit interval ≥12 months. In the OCS sub-analysis including psychosocial variables, lower levels of depression were associated with longer inter-visit intervals. Retention at this tertiary care centre was high. Efforts to maximize attendance should focus on younger patients and those with substance abuse issues. |
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| Keywords: | HIV retention inter-visit interval |
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