Assessing the use of HIV surveillance data to help gauge patient retention-in-care.

BACKGROUND: Improved retention-in-care may enhance health outcomes for people living with HIV/AIDS (PLWHA). Although laboratory surveillance data may be used to gauge retention, no previous reports have compared laboratory surveillance vs. clinic visit-based measures of retention-in-care. We compared laboratory surveillance vs. clinic visit-based approaches for identifying retention status for PLWHA.
METHODS: We examined 2011 patient visit data from the Ruth M. Rothstein CORE Center, Cook County's HIV clinic. We defined retained patients as those with visits every 6 months over 2 years and matched patients classified through visit data against HIV surveillance laboratories reported to the Chicago Department of Health. We determined the sensitivity, specificity, and receiver operator characteristics of varying laboratory surveillance vs. clinic visit measures of retention.
RESULTS: Of patients classified through clinic visit data, 91% of 1714 in-care vs. 22% of 200 out-of-care patients met our most stringent surveillance-based retention definition-having ≥2 viral load/CD4s performed 90 days apart reported by the same laboratory in 2011. Of surveillance laboratory-based definitions for retention, having ≥2 HIV viral load and/or CD4 values at least 3 months apart reported from the same facility possessed the best receiver operator parameters and the receiver operator characteristics' curve comparing several laboratory surveillance vs. clinic visit-based retention measures that had an area under the curve of 0.95.
CONCLUSIONS: Our findings demonstrate that surveillance laboratory data can be used to assess retention-in-care for PLWHA. These data suggest that bi-directional data sharing between public health entities and care providers could advance re-engagement efforts.