Health Care Utilization Behaviors Predict Disengagement From HIV Care: A Latent Class Analysis.
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2018-05
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Abstract
Background
The traditional definition of engagement in HIV care in terms of only clinic attendance and viral suppression provides a limited understanding of how persons living with HIV (PLWH) interact with the health care system.Methods
We conducted a retrospective analysis of patients with ≥1 HIV clinic visits at the Duke Adult Infectious Diseases Clinic between 2008 and 2013. Health care utilization was characterized by 4 indicators: clinic attendance in each half of the year (yes/no), number of emergency department (ED) visits/year (0, 1, or 2+), inpatient admissions/year (0, 1, 2+), and viral suppression (never, intermittent, always). Health care engagement patterns were modeled using latent class/latent transition analysis.Results
A total of 2288 patients (median age, 46.4 years; 59% black, 71% male) were included in the analysis. Three care engagement classes were derived from the latent class model: "adherent" "nonadherent," and "sick." Patients age ≤40 years were more likely to be in the nonadherent class (odds ratio, 2.64; 95% confidence interval, 1.38-5.04) than other cohort members. Whites and males were more likely to transition from nonadherent to adherent the following year. Nonadherent patients were significantly more likely to disengage from care the subsequent year than adherent patients (23.6 vs 0.2%, P < .001).Conclusions
A broader definition of health care engagement revealed distinct and dynamic patterns among PLWH that would have been hidden had only previous HIV clinic attendance had been considered. These patterns may be useful for designing engagement-targeted interventions.Type
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Okeke, Nwora Lance, Meredith E Clement, Mehri S McKellar and Jason E Stout (2018). Health Care Utilization Behaviors Predict Disengagement From HIV Care: A Latent Class Analysis. Open forum infectious diseases, 5(5). p. ofy088. 10.1093/ofid/ofy088 Retrieved from https://hdl.handle.net/10161/26263.
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Scholars@Duke
Mehri Sadri McKellar
Mehri McKellar, MD is a Professor in the Division of Infectious Diseases at Duke University Medical Center, and has almost 20 years of experience in treating persons with HIV (PWH). She serves as one of the primary providers in the Duke ID Clinic.
Since her arrival at Duke University in 2008, one of her major research interests has been on HIV prevention – including rapid HIV testing in non-traditional settings such as emergency rooms and in the community, and more recently, pre-exposure prophylaxis (PrEP). She serves as the Medical Director of the Duke PrEP clinic, which was the first dedicated PrEP Clinic in North Carolina and has seen >500 persons for HIV prevention. Her work with PrEP also extends to persons who inject drugs via syringe services programs and to individuals who are incarcerated.
Jason Eric Stout
My research focuses on the epidemiology, natural history, and treatment of tuberculosis and nontuberculous mycobacterial infections. I am also interested in the impact of HIV infection on mycobacterial infection and disease, and in examining health disparities as they relate to infectious diseases, particularly in immigrant populations.
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