Journal
JAIDS-JOURNAL OF ACQUIRED IMMUNE DEFICIENCY SYNDROMES
Volume 68, Issue 4, Pages 413-419Publisher
LIPPINCOTT WILLIAMS & WILKINS
DOI: 10.1097/QAI.0000000000000489
Keywords
retention in care; viral suppression; age; engagement; HIV
Categories
Funding
- National Institutes of Health [U01-AI069918, U01-AA013566, U24-AA020794, U01-AA020790, U01-AI31834, U01-AI34989, U01-AI34993, U01-AI34994, U01-AI35004, U01-AI35039, U01-AI35040, U01-AI35041, U01-AI35042, U01-AI35043, U01-AI37613, U01-AI37984, U01-AI38855, U01-AI38858]
- Center's for Disease Control and Prevention [CDC200-2006-18797]
- Agency for Healthcare Research and Quality [90047713]
- Health Resources and Services Administration [90051652]
- Canadian Institutes of Health Research, Canada [TGF-96118, HCP-97105, CBR-86906, CBR-94036]
- Canadian Institutes of Health Research (CIHR) New Investigator award
- Ontario Ministry of Health and Long-Term Care
- Government of Alberta, Canada
- Intramural Research Program of the National Cancer Institute, and National Institutes of Health
- Gilead Sciences
- Abbvie
- ViiV Healthcare
- Janssen
- Merck
- Allergan
- Pfizer
- Tibotec
- The National Institutes of Health [U01-AI42590, U01-AI68634, U01-AI68636, U01-AI69432, U01-AI69434, U01-DA036935, U01-HD32632, U10-EY08052, U10-EY08057, U10-EY08067, UL1-RR024131, UL1-TR000083, G12-MD007583, K01-AI071754, K01-AI093197, K23-MH097647, K23 EY013707, K24-DA00432, K24-AI065298]
- National Institutes of Health. [MO1-RR-00052, N02-CP55504, P30-AI027763, P30-AI094189, P30-AI27757, P30-AI27767, P30-AI036219, P30-AI50410, P30-AI54999, P30-MH62246, R01-CA165937, R01-AA16893, R01-DA04334, R01-DA11602, R01-DA12568, R24-AI067039, R56-AI102622, Z01-CP010214, Z01-CP010176]
- EUNICE KENNEDY SHRIVER NATIONAL INSTITUTE OF CHILD HEALTH & HUMAN DEVELOPMENT [U01HD032632] Funding Source: NIH RePORTER
- NATIONAL CANCER INSTITUTE [Z01CP010176, R01CA165937] Funding Source: NIH RePORTER
- NATIONAL CENTER FOR ADVANCING TRANSLATIONAL SCIENCES [UL1TR000083] Funding Source: NIH RePORTER
- NATIONAL CENTER FOR RESEARCH RESOURCES [UL1RR024131, M01RR000052] Funding Source: NIH RePORTER
- NATIONAL EYE INSTITUTE [U10EY008057, U10EY008052, U10EY008067, K23EY013707] Funding Source: NIH RePORTER
- NATIONAL INSTITUTE OF ALLERGY AND INFECTIOUS DISEASES [U01AI068634, P30AI054999, U01AI035004, U01AI069918, U01AI042590, U01AI069432, P30AI027757, P30AI036219, P30AI045008, U01AI035042, P30AI027763, U01AI034994, U01AI035040, R56AI102622, U01AI034993, U01AI037984, K01AI071754, U01AI035041, U01AI034989, U01AI037613, U01AI069434, U01AI068636, UM1AI035043, U01AI031834, U01AI035039, U01AI038855, R24AI067039, P30AI050410, K24AI065298, U01AI035043, U01AI038858, P30AI027767, P30AI094189, K01AI093197] Funding Source: NIH RePORTER
- NATIONAL INSTITUTE OF MENTAL HEALTH [K23MH097647, P30MH062246] Funding Source: NIH RePORTER
- NATIONAL INSTITUTE ON ALCOHOL ABUSE AND ALCOHOLISM [U24AA020794, U01AA020790, R01AA016893, U01AA013566] Funding Source: NIH RePORTER
- NATIONAL INSTITUTE ON DRUG ABUSE [F31DA035713, U01DA036935, R01DA011602, R01DA012568, K24DA000432, R01DA004334] Funding Source: NIH RePORTER
- National Institute on Minority Health and Health Disparities [G12MD007583, U54MD007587] Funding Source: NIH RePORTER
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Background: Retention in care is important for all HIV-infected persons and is strongly associated with initiation of antiretroviral therapy and viral suppression. However, it is unclear how retention in care and age interact to affect viral suppression. We evaluated whether the association between retention and viral suppression differed by age at entry into care. Methods: Cross-sectional analysis (2006-2010) involving 17,044 HIV-infected adults in 14 clinical cohorts across the United States and Canada. Patients contributed 1 year of data during their first full-calendar year of clinical observation. Poisson regression examined associations between retention measures [US National HIV/AIDS Strategy (NHAS), US Department of Health and Human Services (DHHS), 6-month gap, and 3-month visit constancy] and viral suppression (HIV RNA <= 200 copies/mL) by age group: 18-29 years, 30-39 years, 40-49 years, 50-59 years, and 60 years or older. Results: Overall, 89% of patients were retained in care using the NHAS measure, 74% with the DHHS indicator, 85% did not have a 6-month gap, and 62% had visits in 3-4 quarters of the year; 54% achieved viral suppression. For each retention measure, the association with viral suppression was significant for only the younger age groups (18-29 and 30-39 years): 18-29 years [adjusted prevalence ratio (APR) = 1.33, 95% confidence interval (CI): 1.03 to 1.70]; 30-39 years (APR = 1.23, 95% CI: 1.01 to 1.49); 40-49 years (APR = 1.06, 95% CI: 0.90 to 1.22); 50-59 (APR = 0.92, 95% CI: 0.75 to 1.13); >= 60 years (APR = 0.99, 95% CI: 0.63 to 1.56) using the NHAS measure as a representative example. Conclusions: These results have important implications for improving viral control among younger adults, emphasizing the crucial role retention in care plays in supporting viral suppression in this population.
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