Beyond Core Indicators of Retention in HIV Care: Missed Clinic Visits Are Independently Associated With All-Cause Mortality
Beyond Core Indicators of Retention in HIV Care: Missed Clinic Visits Are Independently Associated With All-Cause Mortality
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DOI：
10.1093/cid/ciu603
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发表时间：
2014-11-15
影响因子：
11.8
通讯作者：
Raper, James L.
中科院分区：
文献类型：
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作者：
Mugavero, Michael J.;Westfall, Andrew O.;Raper, James L.
背景。连续护理是国内人类免疫缺陷病毒（HIV）议程的前沿，医学研究所（IOM）和卫生与公众服务部（DHHS）最近发布了临床核心指标。 Core indicators for retention in care are calculated based on attended HIV care clinic visits. Beyond these retention core indicators, we evaluated the additional prognostic value of missed clinic visits for all-cause mortality.Methods. We conducted a multisite cohort study of 3672 antiretroviral-naive patients initiating antiretroviral therapy (ART) during 2000-2010.护理保留率通过 IOM 和 DHHS 核心指标（每 12 个月期间按规定时间间隔进行 2 次就诊）来衡量，并且还作为 ART 启动后 24 个月测量期内错过的初级 HIV 护理就诊（未出现）的计数。通过查询社会保障死亡指数和/或国家死亡指数来确定全因死亡率，并在开始 ART 后 24 个月开始调整生存分析。结果。 Among participants, 64% and 59% met the IOM and DHHS retention core indicators, respectively, at 24 months. Subsequently, 332 patients died during 16 102 person-years of follow-up.开始 ART 后 24 个月内未能达到 IOM 和 DHHS 指标会增加死亡率（风险比 [HR] = 2.23；95% 置信区间 [CI]，1.79-2.80 和 HR = 2.36；95% CI，1.89-2.96）。在根据 IOM 或 DHHS 临床核心指标分类为保留的患者中，超过 2 次漏诊进一步增加了死亡风险（HR = 3.61；95% CI，2.35-5.55 和 HR = 3.62；95% CI，2.30-5.68）。结论。 Beyond HIV retention core indicators, missed clinic visits were independently associated with all-cause mortality. Caution is warranted in relying solely upon retention in care core indicators for policy, clinical, and programmatic purposes.
Background. The continuum of care is at the forefront of the domestic human immunodeficiency virus (HIV) agenda, with the Institute of Medicine (IOM) and Department of Health and Human Services (DHHS) recently releasing clinical core indicators. Core indicators for retention in care are calculated based on attended HIV care clinic visits. Beyond these retention core indicators, we evaluated the additional prognostic value of missed clinic visits for all-cause mortality.Methods. We conducted a multisite cohort study of 3672 antiretroviral-naive patients initiating antiretroviral therapy (ART) during 2000-2010. Retention in care was measured by the IOM and DHHS core indicators (2 attended visits at defined intervals per 12-month period), and also as a count of missed primary HIV care visits (no show) during a 24-month measurement period following ART initiation. All-cause mortality was ascertained by query of the Social Security Death Index and/or National Death Index, with adjusted survival analyses starting at 24 months after ART initiation.Results. Among participants, 64% and 59% met the IOM and DHHS retention core indicators, respectively, at 24 months. Subsequently, 332 patients died during 16 102 person-years of follow-up. Failure to achieve the IOM and DHHS indicators through 24 months following ART initiation increased mortality (hazard ratio [HR] = 2.23; 95% confidence interval [CI], 1.79-2.80 and HR = 2.36; 95% CI, 1.89-2.96, respectively). Among patients classified as retained by the IOM or DHHS clinical core indicators, >2 missed visits further increased mortality risk (HR = 3.61; 95% CI, 2.35-5.55 and HR = 3.62; 95% CI, 2.30-5.68, respectively).Conclusions. Beyond HIV retention core indicators, missed clinic visits were independently associated with all-cause mortality. Caution is warranted in relying solely upon retention in care core indicators for policy, clinical, and programmatic purposes.