TOPLINE

More than 60% of people with HIV newly linked to care in Missouri disengaged from clinic within 2 years, though approximately 60% of those who disengaged later reengaged. Younger individuals and Black patients faced higher risks for both disengagement and reengagement.

METHODOLOGY

• Retrospective cohort study analyzed longitudinal care outcomes among people with HIV newly linked to an HIV clinic in St Louis, Missouri, between January 2015 and March 2020.
• A total of 1110 individuals (median age, 34 years) were included; 77.9% were cisgender men, 67.9% were Black, and 63.5% were men who have sex with men.
• Multistate models tracked 9 mutually exclusive care states over 3 years, including retention, disengagement, reengagement, viral suppression, viremia, and death.
• Disengagement was defined as being more than 90 days late for a scheduled appointment; viral suppression was defined as viral load less than 200 copies/mL within 200 days of the most recent test.
• The median time of observation was 849 days and total follow-up was 2244.5 person-years.

TAKEAWAY

• At 6 months following linkage, 79.9% participants were retained at clinic (54.8% continuously retained and 15.2% reengaged); at 2 years, 66.2% had experienced at least one episode of disengagement, while 39.7% were currently disengaged.
• Among those who disengaged at least once, 60.7% were reengaged at clinic 2 years following the first episode of disengagement.
• Younger individuals aged 18-24 years had higher risk for disengagement (crude hazard ratio [cHR], 1.41; 95% CI, 1.06-1.87) and reengagement (cHR, 2.30; 95% CI, 1.46-3.62) compared with those aged 55 years or older.
• Black individuals had higher risk for both disengagement (cHR, 1.34; 95% CI, 1.12-1.60) and reengagement (cHR, 1.44; 95% CI, 1.11-1.87) compared with non-Hispanic White individuals.

IN PRACTICE

"Our findings demonstrate that disengagement, reengagement, and viremia over time among people with HIV are far more common than previously reported in the state," wrote the authors of the study. "Contrary to how the HIV care continuum is often presented in a linear fashion, these results challenge this simpler depiction by demonstrating the cyclical nature of disengagement and reengagement in HIV care over time."

SOURCE

The study was led by Aditi Ramakrishnan, Department of Medicine, Washington University School of Medicine, St Louis, Missouri. It was published online on August 6 in Open Forum Infectious Diseases.

LIMITATIONS

The study limitations included single center design and misclassification bias. Data on antiretroviral medication refill or adherence pattern were not available.

DISCLOSURES

This study was supported by grants from the National Institutes of Health. One author reported receiving an award from Gilead sciences.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.