Retention in care: is it still a clinically useful indicator for monitoring long-term engagement in HIV care in the treat-all era?

OBJECTIVES

Describe changes in visit frequency by viral suppression (VS) vs. non-VS among people with HIV (PWH) in the US treat-all era.

DESIGN

Observational cohort study.

METHODS

We defined six period-cohorts of PWH in U.S. clinical cohorts of the NA-ACCORD who had initiated antiretroviral therapy and were retained in clinic (attended ≥1 visit in 9 months [mo]) prior to January 1, 2012, 2014, 2016, 2018, 2020, and 2022 (n = 42 389-54 655). We estimated the proportions of PWH retained in clinic, having gaps in visits of >9-15mo or >15mo, and returned to clinic after gaps by time-updated VS status (< vs. ≥200 copies/ml) over 2 years of follow-up using multi-state models, standardized to the 2012 cohort.

RESULTS

PWH in 2012 cohort had a median age of 51 years (IQR: 43-58); 85% were cismen; 43% were non-Hispanic Black; 15% were Hispanic; 84% had VS at baseline. The proportions of PWH having >9-15mo gaps with prior VS increased from 2012 (3.8%; 95% CI: 3.6%, 3.9%) to 2022 (6.9%; 95% CI: 6.5%, 7.3%). The proportions of PWH having >15mo gaps with prior VS increased from 2012 (6.6%; 95% CI: 6.4%, 6.8%) to 2022 (10.7%; 95% CI: 10.2%, 11.2%). The proportions of PWH with >9-15mo and >15mo gaps with non-VS remained low from 2012 to 2022. The majority of PWH returned to clinic after gaps.

CONCLUSIONS

Over the past 12 years, PWH with prior VS had more gaps in visits that did not meet a minimum of 6-mo visit frequency consistent with standard retention indicators. Better indicators are needed to optimally direct resources for care engagement and VS.