Engagement in primary HIV-medical care:Retention in care issues in a Southern Rural State

Background:We sought to ascertain factors associated with failure to remain in primary HIV medical care in a rural Southern state. Our conceptual framework was the Andersen behavioral health model.

Methods: We performed a retrospective cohort analysis of the care status of all HIV-infected, non-pregnant adults reported to the South Carolina HIV/AIDS Reporting System during 2004-2006 (n=13,042). Persons receiving a viral load test or CD4 cell count during a 12-month period were defined as being in care for that period. Care status categories were: In Care (IC), care all three years; Not In Care (NIC) no care across the period; and Transitioning (TC), care received during one or more years but not consistently. Reporting of HIV laboratory markers is mandatory by law in SC. We report multinomial logistic regression results.

Results: Only 34.7% of HIV-infected adults remained in care across the study period. In unadjusted analysis, blacks were less likely than whites to be NIC rather than IC (OR, 0.77; C.I, 0.70, 0.84); women were more likely to be NIC than were men (OR, 1.36; C.I, 1.25, 1.49). In adjusted analysis, blacks continued to be less likely than whites to be NIC (OR, 0.88; C.I, 0.78, 0.99), but women had lower odds of being NIC than men (OR, 0.79; C.I, 0.69, 0.90).

Conclusions: Significant proportions of the South Carolina HIV-infected adult population was not in care or transitioned in and out of care. Targeted programs are needed for the populations most likely to transit or not be in care.