XIX International AIDS Conference


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MOPDC0305 - Poster Discussion Session

Patient migration significantly impacts estimates of engagement in HIV care and attainment of an undetectable HIV-RNA level in a cohort of newly HIV-diagnosed individuals

Presented by Sarah Rowan (United States).

S. Rowan1,2, S. Johnson1, M. Thrun1,2, E. Daniloff3, D. Reirden4, W. Burman1,2, E. Connick1, E. Gardner1,2

1University of Colorado Denver, Division of Infectious Diseases, Denver, United States, 2Denver Public Health, Denver, United States, 3Colorado Department of Public Health and Environment, Denver, United States, 4The Children's Hospital, Aurora, United States

Background: Engagement in HIV care is a dynamic process. We sought to describe engagement-in-care over time in a newly HIV-diagnosed cohort.
Methods: Retrospective review of engagement-in-care among newly-diagnosed HIV-infected individuals at Denver Health and University of Colorado Hospital, 2005-2009. Client-level data was obtained from three public HIV providers, two clinical trial groups, and mandated Colorado state HIV laboratory reporting databases. Engagement in care required a visit or HIV-labs in a 6-month interval. Documentation in the medical record was required for out-of-state designation.
Results: From 2005-2009, 616 individuals were newly HIV-diagnosed; 9% were female, 34% Hispanic, 16% Black, and 78% men who had sex with men. Within 6 months of HIV diagnosis, 76% of individuals had at least one outpatient HIV-care visit. In a missing=failure analysis, 54-58% of patients were engaged in care and 33-37% had HIV-RNA < 200 copies/ml after 2.5 years (Figure1). However, a significant proportion of individuals moved out-of-state or expired causing an underestimate of engagement in this analysis. Within 5 years of diagnosis 14% of individuals moved out-of-state and 4% expired. Excluding these individuals, 71% of the cohort were engaged in care and 48% had HIV-RNA < 200 cps/ml 5 years after diagnosis (Figure 2). Among those engaged in care, the percentage of individuals with HIV-RNA levels < 200 cps/ml increased from 28% in the first 6 months after diagnosis to 67% 5 years after diagnosis (Figure 3).
Conclusions: In missing=failure analyses, 36% of individuals had an undetectable viral load 5 years after diagnosis but this increased to 48% after excluding individuals who expired or were known to move out of state. Out-of-state migration accounted for 14% of individuals who appeared to be non-engaged in care, a minimal estimate given the strict out-of-state designation criteria. Systems to track migration are needed to allow accurate assessment of engagement-in-care at the population level.

Engagement-in-care five years after HIV diagnosis
[Engagement-in-care five years after HIV diagnosis]

Engagement-in-care, migration and death censored
[Engagement-in-care, migration and death censored]

Percentages of individuals HIV-RNA <200cps/ml
[Percentages of individuals HIV-RNA <200cps/ml]

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