Retention in HIV Care Still Matters: A Longitudinal Multisite Analysis.

Introduction: Retention in care has recently been de-emphasized as a key national HIV health metric, and its relevance in the era of more effective antiretroviral therapy (ART) regimens remains unclear. We assessed the relationship between retention in care and sustained viral suppression (SVS) over a 2-year period for newly established and previously established people with HIV (PWH).

Methods: We analyzed data from seven Center for AIDS Research Network of Integrated Clinical Systems (CNICS) sites using modified Poisson regression with generalized estimating equations. PWH were categorized into two cohorts: (1) newly established: had initial CNICS visit in 2017 and ART-naïve at initial CNICS visit; and (2) previously established: had initial CNICS visit prior to January 1, 2017 or PWH who were not ART-naïve at initial CNICS visit in 2017. Retention was measured using both missed and kept visit-based metrics. The primary outcome was SVS over two years, defined as all viral load measurements ≤200 copies/mL.

Results: Among 11,994 patients, 11,573 were previously established in HIV care and 421 were newly established and ART-naive. A higher proportion of previously vs. newly established patients were retained in care and achieved SVS. In both cohorts, when controlling for age, sex, race, and risk factor for HIV acquisition, both retention measures were observed to be a predictor of SVS.

Conclusion: Retention in care remains a clinically valuable metric for all PWH. Healthcare providers should emphasize consistent care engagement, and national HIV/AIDS strategies should reincorporate retention as a key indicator for improving HIV health outcomes.