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Recorded presentation

Maureen H. Rumptz, PhD¹, Serena Rajabiun, MPH², Carol Tobias, MMHS², and Judith Bradford, PhD³. (1) Program Design & Evaluation Services, Multnomah County Health Department/Oregon State Public Health, 800 NE Oregon St., Suite 550, Portland, OR 97232, 971-673-0606, maureen.h.rumptz@state.or.us, (2) Health and Disability Working Group, Boston University School of Public Health, 374 Congress St., Suite 502, Boston, MA 02210, (3) The Fenway Institute, Fenway Community Health Center, 7 Haviland Street, Boston, MA 02115

Background: Sporadic users of HIV medical care present challenges to the health care system such as higher treatment costs and medication resistance. Retaining sporadic users in care is critical for slowing the progression of HIV disease and improving quality of life. This paper describes sporadic users of care recruited from a multisite intervention project at baseline and 6 month follow-up.

Methods: Sporadic users of care were defined at baseline as HIV-positive persons with less than 2 primary medical care visits, more than 1 missed appointment, and no CD4 or viral load test in the previous 6 months. Participants were from ten urban sites with interventions to improve retention in medical care. Chi-squares compared sporadic users (n=250) to persons considered “stable in care” (n=295). Paired T-tests and McNemar tests were used to compare changes between baseline and 6 month follow-up (n=148).

Results: Sporadic users were more likely to be female, heterosexual, African American, with a history of hospitalization for mental health problems. They were more likely to report barriers to care due to structural issues with the health care system and health beliefs. They were less likely to be taking HIV medications and have a case manager. At 6 months, these participants reported a significant decrease in barriers to care and number of missed appointments and significant improvement in engagement with health care providers.

Conclusions: Addressing health beliefs, structural barriers, and relationship with health care providers are important for improving retention in care. Program interventions addressing these issues will be discussed.

Learning Objectives: