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AIDS Care
Psychological and Socio-medical Aspects of AIDS/HIV
Volume 27, 2015 - Issue 5
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Original Articles

Moving toward a novel and comprehensive behavioral composite of engagement in HIV care

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Pages 660-664 | Received 18 Aug 2014, Accepted 29 Oct 2014, Published online: 04 Dec 2014
 

Abstract

Suboptimal engagement in HIV care increases the risk of HIV-related morbidity and mortality; however, a comprehensive and practical measure of engagement in care does not exist. The objective of our study was to identify and develop a composite of engagement in HIV care. From May to August 2013, we conducted a cross-sectional study of HIV-positive individuals who consented to participate in an online survey. Engagement in care was assessed by the following self-reported variables: (1) having attended an HIV health-care provider appointment in the past six months, (2) reporting a scheduled future HIV health-care provider appointment, (3) knowing their last CD4+ cell count, (4) knowing their antiretroviral (ARV) medication names, (5) reporting ARV adherence ≥80% on the visual analog scale (VAS) and rating scale, (6) reporting adherence ≥90% on the VAS and rating scale, and (7) not having missed all ARVs for at least four days in a row in the past three months. To create the composite of engagement in care, the presence or absence of these variables were summed and categorized (7 = “high engagement,” 5–6 = “moderate engagement,” and 0–4 = “low engagement”). We examined the correlation between this composite and self-reported HIV viral load (VL; detectable versus undetectable) in a logistic regression model. We surveyed 1259 HIV-positive individuals: 85% reporting an undetectable VL and 67% reporting excellent adherence. Approximately 89%, 88%, and 67% of those with high, moderate, and low engagement, respectively, had an undetectable VL. Having moderate engagement was associated with 3.5-fold higher odds, and high engagement was associated with 4.0-fold higher odds of virologic undetectability compared to low engagement (overall p-value < 0.0001). Our data indicate that this novel and comprehensive composite of engagement may be a useful tool in clinical and research settings given its high correlation with virologic outcomes. Future research should validate this composite in other populations and examine it prospectively.

Additional information

Funding

The project described was supported by National Institutes of Health (NIH) [grant number K23MH097649], [grant number K24MH087220], and [grant number K24DA037034]. The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH.

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