Patterns of HIV service use and HIV viral suppression among patients treated in an academic infectious diseases clinic in North Carolina

AIDS Behav. 2015 Apr;19(4):694-703. doi: 10.1007/s10461-014-0907-8.


Irregular participation in HIV medical care hinders HIV RNA suppression and impacts health among people living with HIV. Cluster analysis of clinical data from 1,748 patients attending a large academic medical center yielded three HIV service usage patterns, namely: 'engaged in care', 'sporadic care', and 'frequent use'. Patients 'engaged in care' exhibited most consistent retention (on average, >88 % of each patient's observation years had ≥2 visits 90 days apart), annualized visit use (2.9 mean visits/year) and viral suppression (>73 % HIV RNA tests <400 c/mL). Patients in 'sporadic care' demonstrated lower retention (46-52 %), visit use (1.7 visits/year) and viral suppression (56 % <400 c/mL). Patients with 'frequent use' (5.2 visits/year) had more inpatient and emergency visits. Female, out-of-state residence, low attendance during the first observation year and detectable first-observed HIV RNA were early predictors of subsequent service usage. Patients 'engaged in care' were more likely to have HIV RNA <400 than those receiving sporadic care. Results confirm earlier findings that under-utilization of services predicts poorer viral suppression and health outcomes and support recommendations for 2-3 visits/year.

Publication types

  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Academic Medical Centers
  • Adult
  • Ambulatory Care Facilities
  • Antiretroviral Therapy, Highly Active*
  • Cluster Analysis
  • Cohort Studies
  • Emergency Service, Hospital / statistics & numerical data
  • Female
  • HIV Infections / blood
  • HIV Infections / drug therapy*
  • Health Services / statistics & numerical data*
  • Hospitalization / statistics & numerical data
  • Humans
  • Infectious Disease Medicine
  • Insurance, Health
  • Male
  • Middle Aged
  • North Carolina
  • Patient Participation
  • Residence Characteristics
  • Sex Factors
  • Treatment Outcome
  • Viral Load*