Development and application of a new measure of engagement in out‐patient HIV care. Issue 4 (18th August 2016)

• Record Type: Journal Article
• Authors: Howarth, AR; Burns, FM; Apea, V; Jose, S; Hill, T; Delpech, VC; Evans, A; Mercer, CH; Michie, S; Morris, S; Sachikonye, M; Sabin, C
• Other Names: Ainsworth Jonathan investigator.; Allan Sris investigator.; Anderson Jane investigator.; Babiker Abdel investigator.; Chadwick David investigator.; Dunn David investigator.; Fisher Martin investigator.; Gazzard Brian investigator.; Gilson Richard investigator.; Gompels Mark investigator.; Hay Phillip investigator.; Johnson Margaret investigator.; Kegg Stephen investigator.; Leen Clifford investigator.; Martin Fabiola investigator.; Nelson Mark investigator.; Orkin Chloe investigator.; Palfreeman Adrian investigator.; Phillips Andrew investigator.; Pillay Deenan investigator.; Post Frank investigator.; Pritchard Jillian investigator.; Schwenk Achim investigator.; Tariq Anjum investigator.; Trevelion Roy investigator.; Walsh John investigator.; Thornton Alicia investigator.; Huntington Susie investigator.; Glabay Adam investigator.; Perry N. investigator.; Tilbury S. investigator.; Youssef E. investigator.; Churchill D. investigator.; Everett R. investigator.; Asboe D. investigator.; Mandalia S. investigator.; Korat H. investigator.; Taylor C. investigator.; Gleisner Z. investigator.; Ibrahim F. investigator.; Campbell L. investigator.; Brima N. investigator.; Williams I. investigator.; Youle M. investigator.; Lampe F. investigator.; Smith C. investigator.; Tsintas R. investigator.; Chaloner C. investigator.; Hutchinson S. investigator.; Mackie N. investigator.; Winston A. investigator.; Weber J. investigator.; Ramzan F. investigator.; Carder M. investigator.; Lynch J. investigator.; Hand J. investigator.; Souza C. investigator.; Anderson J. investigator.; Munshi S. investigator.; Miller S. investigator.; Wood C. investigator.; Leen C. investigator.; Wilson A. investigator.; Morris S. investigator.; Memon K. investigator.; Lewszuk A. investigator.; Cope E. investigator.; Gibson J. investigator.; Main P. investigator.; Mitchell S. investigator.; Hunter M. investigator.; Dhillon M. investigator.; Russell‐Sharpe S. investigator.; Harte A. investigator.; Clay S. investigator.; Tariq A. investigator.; Spencer H. investigator.; Jones R. investigator.; Cumming S. investigator.; Atkinson C. investigator.;
• Is Part Of: HIV medicine. Volume 18:Issue 4(2017:Apr.)
• Page Start: 267
• Page End: 274
• Publication Date: 2016-08-18
• Subjects: cohort study -- HIV -- out‐patient care -- patient engagement -- retention measure; HIV infections -- Treatment -- Periodicals; HIV-positive persons -- Periodicals; HIV infections -- Treatment -- Decision making -- Periodicals; 616.9792
• DOI: 10.1111/hiv.12427
• Languages: English
• ISSNs: 1464-2662

Abstract

Abstract : Objectives: Commonly used measures of engagement in HIV care do not take into account that the frequency of attendance is related to changes in treatment and health status. This study developed a new measure of engagement in care (EIC) incorporating clinical factors. Methods: We conducted semi‐structured interviews with eight HIV physicians to identify factors associated with the timing of patients' next scheduled appointments. These factors informed the development of an algorithm to classify each month of follow‐up as "in care" (on or before the time of the next expected attendance) or "out of care" (after the time of the next expected attendance). The EIC algorithm was applied to data from the UK Collaborative HIV Cohort (UK CHIC) study, a large clinical cohort study. Results: The interviews indicated that time to next appointment varied depending on psychosocial and physical comorbidities, and clinical factors (time since diagnosis, AIDS diagnosis, treatment status, CD4 count and viral load). The resulting EIC algorithm was applied to 44 432 patients; 83.9% of the 3 021 224 person‐months were "in care". Greater EIC was independently associated with older age, white ethnicity, HIV acquisition through sex between men, current use of antiretroviral therapy (ART), a higher nadir CD4 count, later calendar year and being seen at the clinic for the first time within the last year. Conclusions: This algorithm describing engagement in HIV care incorporates a time‐updated measure of patients' treatment and health status. It adds to the options available for measuring this key performance indicator.