Lost to care: individual and neighborhood characteristics associated with the out-of-care HIV positive patient population of an outpatient HIV/AIDS clinic in Bexar County, TX, 2008-2013
While HIV has become a highly treatable disease, adherence to a strict healthcare treatment regimen is required. Thus, lack of patient retention among HIV patients has become an important public health concern, because it contributes to further HIV transmission, morbidity, disability and mortality. Previous research has noted the importance of health behaviors, demographic characteristics, and neighborhood characteristics for the retention in care of HIV patients; however few studies have examined these factors in a predominantly Hispanic area. The purpose of this research was to fill this gap by examining the effect of individual and contextual level predictors on the risk of being lost to care in an HIV positive patient population of an HIV clinic in South Central Texas using a comprehensive multilevel theoretical framework. The analysis relied on medical records of adult HIV patients, and utilized bivariate statistics, logistic regression models, and multilevel logistic regression models.
This research demonstrated that – at the individual level – older age, Hispanic ethnicity, public health insurance, being married, testing positive for STIs, and living more than a mile from the clinic were associated with being lost to care. At the neighborhood level, the analysis showed that the Barrio Effect was not associated with the risk of being lost to care for HIV-positive patients in general. Future research should investigate alternative ways of capturing neighborhood influence on the risk of being lost to care, as well as test the framework against other HIV patient populations in majority-minority settings.