Clinical and HIV Surveillance Data to Determine Care Status for People with HIV in Washington, DC

Background: We examined factors related to being out of care (OOC) or re-entering care after clinic transfer among people with HIV (PWH) in Washington, DC using clinical and linked surveillance data from the DC Department of Health (DC Health). Methods: Using DC Cohort HIV care encounters and labs, linked surveillance data, and chart review, we determined if participants were (1) engaged in care, (2) OOC, (3) died, (4) withdrew, (5) clinic-reported transfer, (6) surveillance-based transfer (using DC Health data), or (7) undetermined. Of the clinic-reported transfers, we used surveillance data to determine whether participants re-entered care after transfer. We evaluated associations between participant characteristics, being OOC and re-entering care using logistic regression. Results: We evaluated 12,563 DC Cohort participants, 6,557 (52.5%) were engaged in care, 748 (6.0%) OOC, 1,893 (15.0%) clinic-reported transfers, 1,692 (13.5%) surveillance-based transfers, 1,418 (11.0%) died, 41 (0.3%) withdrew, and 214 (1.7%) were undetermined. Of clinic-reported transfers, 832 (44.0%) re-entered care, with 80.9% achieving viral suppression (VS) (< 200 copies/mL). In the adjusted analysis, females, older age, non-Hispanic Black race, longer time since HIV diagnosis, CD4 ≥ 500 cells/µL, former or never smoking, and public insurance were associated with being engaged in care. Similarly, non-Hispanic Black race, non-Hispanic White race, non-VS, Ryan White clinic, former alcohol abuse, and temporary/unstable housing were associated with re-entering care among the clinic-reported transfers, after adjusting for covariates. Conclusions: Individual, clinical, and structural factors were associated with being OOC or care re-entry. Targeted interventions addressing these factors may improve sustained HIV care and reduce transmission.