Measuring Retention in HIV Care: The Elusive Gold Standard
Measuring Retention in HIV Care: The Elusive Gold Standard
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DOI：
10.1097/qai.0b013e318273762f
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发表时间：
2012-12-15
影响因子：
3.6
通讯作者：
Giordano, Thomas P.
中科院分区：
文献类型：
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作者：
Mugavero, Michael J.;Westfall, Andrew O.;Giordano, Thomas P.
背景：衡量艾滋病毒初级保健的保留率是复杂的，因为护理包括在不同时间间隔安排的多次访问。我们评估了预测病毒载量（VL）抑制的6种常用保留措施以及措施之间的相关性。方法：采用美国疾病控制与预防中心/卫生资源与服务管理局（CDC/HRSA）实施护理干预前12个月的临床患者水平数据。根据预定的初级HIV提供者就诊，计算每个患者的六项保留措施：计数和二分类错过就诊、就诊依从性、6个月间隔、4个月就诊持续性和HRSA HIV/AIDS局（HRSA HAB）保留措施。Spearman相关系数和单独的未调整逻辑回归模型分别比较了保留措施彼此之间和12个月VL抑制。用c统计量评估每个措施的区分能力。结果：在10053例患者中，8235例（82%）有12个月的VL测量，6304例（77%）实现抑制（VL < 400拷贝/mL）。所有6项保留措施均与VL抑制显著相关（P < 0.0001）（优势比；95% CI, c-statistic）：未就诊计数（0.73；0.71至0.75,0.67）、未就诊二分类（3.2；2.8至3.6,0.62）、就诊依从性（3.9；3.5至4.3,0.69）、间隙（3.0；2.6至3.3,0.61）、就诊稳定性（2.8；2.5至3.0,0.63）和HRSA HAB（3.8； 3.3至4.4,0.59）。包含“未出现”访问的测量高度相关（Spearman系数= 0.83-0.85），仅基于保留访问的测量也是如此（Spearman系数= 0.72-0.77）。这两组测量的相关系数较低（范围= 0.16-0.57）。结论：六种保留测量指标之间存在广泛的相关性，但每种测量指标对VL抑制都有显著的相关性和适度的歧视。这些数据表明，并不存在明确的黄金标准，留存措施的选择可能要根据具体情况而定。
Background: Measuring retention in HIV primary care is complex, as care includes multiple visits scheduled at varying intervals over time. We evaluated 6 commonly used retention measures in predicting viral load (VL) suppression and the correlation among measures.Methods: Clinic-wide patient-level data from 6 academic HIV clinics were used for 12 months preceding implementation of the Centers for Disease Control and Prevention/Health Resources and Services Administration (CDC/HRSA) retention in care intervention. Six retention measures were calculated for each patient based on scheduled primary HIV provider visits: count and dichotomous missed visits, visit adherence, 6-month gap, 4-month visit constancy, and the HRSA HIV/AIDS Bureau (HRSA HAB) retention measure. Spearman correlation coefficients and separate unadjusted logistic regression models compared retention measures with one another and with 12-month VL suppression, respectively. The discriminatory capacity of each measure was assessed with the c-statistic.Results: Among 10,053 patients, 8235 (82%) had 12-month VL measures, with 6304 (77%) achieving suppression (VL < 400 copies/mL). All 6 retention measures were significantly associated (P < 0.0001) with VL suppression (odds ratio; 95% CI, c-statistic): missed visit count (0.73; 0.71 to 0.75, 0.67), missed visit dichotomous (3.2; 2.8 to 3.6, 0.62), visit adherence (3.9; 3.5 to 4.3,0.69), gap (3.0; 2.6 to 3.3, 0.61), visit constancy (2.8; 2.5 to 3.0, 0.63), and HRSA HAB (3.8; 3.3 to 4.4, 0.59). Measures incorporating "no-show" visits were highly correlated (Spearman coefficient = 0.83-0.85), as were measures based solely on kept visits (Spearman coefficient = 0.72-0.77). Correlation coefficients were lower across these 2 groups of measures (range = 0.16-0.57).Conclusions: Six retention measures displayed a wide range of correlation with one another, yet each measure had significant association and modest discrimination for VL suppression. These data suggest there is no clear gold standard and that selection of a retention measure may be tailored to context.