High retention in HIV care at a tertiary care centre in Toronto, Canada

AIDS Care. 2018 Feb;30(2):246-254. doi: 10.1080/09540121.2017.1349278. Epub 2017 Jul 5.

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.

Keywords: HIV; inter-visit interval; retention.

MeSH terms

  • Adult
  • Age Factors
  • Anti-HIV Agents / administration & dosage*
  • Appointments and Schedules
  • CD4 Lymphocyte Count
  • Cohort Studies
  • Continuity of Patient Care*
  • Female
  • HIV Infections / drug therapy*
  • HIV Infections / virology
  • Humans
  • Male
  • Middle Aged
  • Ontario
  • Patient Compliance*
  • Risk Factors
  • Substance Abuse, Intravenous
  • Surveys and Questionnaires
  • Tertiary Care Centers
  • Time Factors
  • Viral Load*

Substances

  • Anti-HIV Agents