HIV Care Retention and the Goal of an AIDS-Free Generation

Laura W. Cheever, MD, ScM; Rupali K. Doshi, MD, MS


February 07, 2013

Next Steps and Goals for the Future

Although great strides have been made in the last few years to develop an evidence base, gaps remain and more work remains to be done. Some of the unanswered questions include:

What is the best way to quickly integrate a newly diagnosed patient into care for best retention?

What should be done to support patients in care to prevent loss to follow-up?

How should clinics monitor loss to care, and when should clinic staff intervene?

What is the best way to re-engage patients who are lost to follow-up?

Although many HIV clinics have implemented programs focused on retention with success at improving retention rates in the last several years, these programs do not retain 100% of patients in care. Some of the patients lost to care likely need larger structural interventions beyond the current capacity of a clinical site, such as long-term housing support, to remain in care. For some patients, HIV-related stigma, poverty, mental illness, substance abuse, care for dependents, food insecurity, and interpersonal violence, as well as difficulties with the fragmented US healthcare system, threaten to be overwhelming barriers to continuous engagement in care. Municipal and state health departments have important roles and responsibilities in monitoring retention across their jurisdictions to assure that a continuum of services is available to meet the needs of these vulnerable patient populations.

In order to curb the HIV epidemic, reduce disparities, and meet the goals of the National HIV/AIDS Strategy, we must keep patients retained and fully engaged in care. Great improvements in retention in care are needed if we are to reach the promise of an AIDS-free generation.