Delayers and Dropouts : Dropping Off the Care Cascade

Objectives.   We examined patterns, predictors, and self-reported reasons for delaying initial entry into HIV care (>3 months) and/or one or more episodes of dropping out’ of care (>6 months) among persons living with HIV (PLWH) in New York City and northern suburban.

Methods.  Data are provided by a cohort study of PLWH recruited using probability sampling from HIV service settings.  Comprehensive in-person interviews were conducted every 12-18mos.   Logistic regression analyses examine delayers based on interviews conducted 2009-12,  and random effect logistic models conducted for the dropouts analyses using interviews conducted from 2001-2014 (n=1586).   Models include a wide range of individual, situational, and service need variables.   Qualitative analyses identified reasons for delaying entry or dropping out of care.  

Results.    Diagnosis after 2002 is associated with lower odds of delayed entry into care.   Homelessness at diagnosis is associated with higher odds (OR 2.05) and having a regular source of medical care prior to diagnosis (OR 0.58) with lower odds of delayed care.   Recent drug use (OR 2.78), mental health symptoms (OR 1.39),  unstable housing, food insecurity, and transportation needs are associated with significantly greater odds of dropping out of care.   Receipt of case management services is associated with lower odds of dropping out of care, especially case management oriented toward addressing social service needs (OR 0. 60).

 Conclusions.    Contextual factors, behavioral health and social service needs, and services to address such needs, are the most important predictors of delayed entry into HIV medical care or lack of retention in care over time.