AIDS Care, 2015 Vol. 27, No. 7, 892–899, http://dx.doi.org/10.1080/09540121.2015.1009361
Examining the relationship between multiple comorbidities and retention in HIV medical care: a retrospective analysis Timothy N. Crawford* School of Nursing, University of Louisville, Louisville, KY, USA (Received 21 April 2014; accepted 15 January 2015) Retention in medical care among people living with HIV (PLWH) is a major component in properly managing the disease. As PLWH age, diagnoses of comorbid conditions become common and it may be important to understand how these conditions may impact engagement in care, in particular retention in HIV medical care. A secondary data analysis was conducted to determine the relationship between multiple comorbid conditions and retention in HIV care among patients who sought HIV care between 2003 and 2011. Retention in care was defined as having two clinic visits separated by ≥3 months within a 12-month period. Logistic regression was conducted to determine if multiple comorbid conditions were associated with optimal retention (100%) versus suboptimal retention (1 January 2011). Study measures Baseline demographic and clinical characteristics were abstracted from the medical records. Demographic data collected included date of birth, sex, race (white, black, and other), income ($10,000), marital status (married, divorced, single, and widowed), history of tobacco use, alcohol abuse, and substance abuse. HIV risk behavior was collected and was categorized as men who have sex with men (MSM), heterosexual contact, injection drug user (IDU), and other. Clinical data collected included insurance type (none, Medicaid, Medicare, and private), AIDS diagnosis, hepatitis C diagnosis, HAART use, and CD4 cell count and baseline viral load at initial study visit. The primary measure of interest for this study was presence of comorbidities. The occurrence and type of comorbidities were abstracted from the medical records. The comorbidities observed in this population included renal disease, cancer (non-AIDS defining), cardiovascular (hypertension, heart disease, and coronary artery disease), cerebrovascular (stroke), respiratory
893
(chronic obstructive pulmonary disease and asthma), diabetes, and depression. There were no other conditions observed in this sample. Since the purpose of the study was to assess the relationship between the number of comorbidities diagnosed and retention in care, comorbidities diagnosed for each patient were counted and grouped together. Patients were grouped together based on the number of comorbidities diagnosed (i.e., none, one condition, and two or more conditions). Outcome measure The primary outcome measure for this study was retention in HIV care, and was defined using the Health Resources and Services Administration’s (HRSA) definition, as having at least two HIV outpatient visits separated by ≥3 months within a 12-month period (HRSA). The percentage of 12-month periods where the retention criteria was met was calculated for each patient (i.e., number of 12-month periods where retention was met divided by the number of observed 12-month periods); patients were then divided into two groups based on the percentage of 12-month periods where they were fully retained in care. The two groups were optimal retainers (100%) and suboptimal retainers (
Examining the relationship between multiple comorbidities and retention in HIV medical care: a retrospective analysis Timothy N. Crawford* School of Nursing, University of Louisville, Louisville, KY, USA (Received 21 April 2014; accepted 15 January 2015) Retention in medical care among people living with HIV (PLWH) is a major component in properly managing the disease. As PLWH age, diagnoses of comorbid conditions become common and it may be important to understand how these conditions may impact engagement in care, in particular retention in HIV medical care. A secondary data analysis was conducted to determine the relationship between multiple comorbid conditions and retention in HIV care among patients who sought HIV care between 2003 and 2011. Retention in care was defined as having two clinic visits separated by ≥3 months within a 12-month period. Logistic regression was conducted to determine if multiple comorbid conditions were associated with optimal retention (100%) versus suboptimal retention (1 January 2011). Study measures Baseline demographic and clinical characteristics were abstracted from the medical records. Demographic data collected included date of birth, sex, race (white, black, and other), income ($10,000), marital status (married, divorced, single, and widowed), history of tobacco use, alcohol abuse, and substance abuse. HIV risk behavior was collected and was categorized as men who have sex with men (MSM), heterosexual contact, injection drug user (IDU), and other. Clinical data collected included insurance type (none, Medicaid, Medicare, and private), AIDS diagnosis, hepatitis C diagnosis, HAART use, and CD4 cell count and baseline viral load at initial study visit. The primary measure of interest for this study was presence of comorbidities. The occurrence and type of comorbidities were abstracted from the medical records. The comorbidities observed in this population included renal disease, cancer (non-AIDS defining), cardiovascular (hypertension, heart disease, and coronary artery disease), cerebrovascular (stroke), respiratory
893
(chronic obstructive pulmonary disease and asthma), diabetes, and depression. There were no other conditions observed in this sample. Since the purpose of the study was to assess the relationship between the number of comorbidities diagnosed and retention in care, comorbidities diagnosed for each patient were counted and grouped together. Patients were grouped together based on the number of comorbidities diagnosed (i.e., none, one condition, and two or more conditions). Outcome measure The primary outcome measure for this study was retention in HIV care, and was defined using the Health Resources and Services Administration’s (HRSA) definition, as having at least two HIV outpatient visits separated by ≥3 months within a 12-month period (HRSA). The percentage of 12-month periods where the retention criteria was met was calculated for each patient (i.e., number of 12-month periods where retention was met divided by the number of observed 12-month periods); patients were then divided into two groups based on the percentage of 12-month periods where they were fully retained in care. The two groups were optimal retainers (100%) and suboptimal retainers (
