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AIDS Care. 2019 Aug 28:1-6. doi: 10.1080/09540121.2019.1659918. [Epub ahead of print]

Are missed- and kept-visit measures capturing different aspects of retention in HIV primary care?

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Department of Social Work, University of Alabama at Birmingham , Birmingham , AL , USA.
School of Social Work, University of Michigan , Ann Arbor , MI , USA.
School of Public Health, Department of Biostatistics, University of Alabama at Birmingham , Birmingham , AL , USA.
School of Medicine, Department of Medical Education, University of Alabama at Birmingham , Birmingham , AL , USA.
Department of Medicine, Boston University School of Medicine , Boston , MA , USA.
Department of Health Law, Policy & Management, Boston University School of Public Health , Boston , MA , USA.
Centers for Disease Control and Prevention , Atlanta , GA , USA.
Baylor College of Medicine , Houston , TX , USA.
School of Medicine, Johns Hopkins University , Baltimore , MD , USA.
School of Medicine, University of Miami , Miami , FL , USA.
Downstate Medical Center, State University of New York , Brooklyn , NY , USA.
School of Medicine, Department of Medicine, University of Alabama at Birmingham , Birmingham , AL , USA.


The literature recognizes six measures of retention in care, an integral component of the HIV Continuum of Care. Given prior research showing that different retention measures are differentially associated with HIV health outcomes (e.g., CD4 count and viral suppression), we hypothesized that different groups of people living with HIV (PLWH) would also have differential retention outcomes based on the retention measure applied. We conducted a cross-sectional analysis of multisite patient-level medical record data (nā€‰=ā€‰10,053) from six academically-affiliated HIV clinics using six different measures of retention. Principal component analysis indicated two distinct retention constructs: kept-visit-measures and missed-visit measures. Although black (compared to white) PLWH had significantly poorer retention on the three missed-visit measures, race was not significantly associated with any of the three kept-visit measures. Males performed significantly worse than females on all kept-visit measures, but sex differences were not observed for any missed-visit retention measures. IDU risk transmission group and younger age were associated with poorer retention on both missed- and kept-visit retention measures. Missed- and kept-visit measures may capture different aspects of retention, as indicated in the observed differential associations among race, sex, age, and risk transmission group. Multiple measures are needed to effectively assess retention across patient subgroups.


HIV; continuum of care; kept visits; missed visits; retention in care

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