A novel index for predicting HIV care retention

A newly developed 10-point questionnaire shows promise at predicting which HIV patients drop out of care and are at risk for virologic failure.

Engagement in care is an important determinant of good clinical outcomes for HIV infection. Loss to follow-up has been identified as an important obstacle to achieving higher rates of sustained viral suppression, but validated prospective assessments of risk for and interventions to prevent disengagement are not currently available.

To identify perceptions of engagement before poor outcomes occur, investigators developed and assessed a patient-centred questionnaire. Using input from patients and providers, the investigators evaluated numerous questions and combinations, resulting in a final 10-item measure of self-reported engagement in care, including 5 possible responses per question, resulting in an HIV Index score.

The index was validated with 3,296 patients from 7 U.S.-based CNICS clinics (Centres for AIDS Research Network of Integrated Clinical Systems).

Questions in the final questionnaire included "How much does your provider respect what you say?" and "How well does the HIV provider explain things?" Lower HIV Index scores were linked to depression and anxiety, increased use of alcohol and stimulants, and increased internalised stigma.

Higher HIV Index scores were associated with higher self-reported adherence, attendance at appointments, and viral suppression.