{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,7]],"date-time":"2026-08-07T15:35:40Z","timestamp":1786116940063,"version":"build-2736575974"},"reference-count":42,"publisher":"Oxford University Press (OUP)","issue":"8","license":[{"start":{"date-parts":[[2026,8,6]],"date-time":"2026-08-06T00:00:00Z","timestamp":1785974400000},"content-version":"vor","delay-in-days":5,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"funder":[{"DOI":"10.13039\/100000002","name":"National Institutes of Health","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100006108","name":"National Center for Advancing Translational Sciences","doi-asserted-by":"publisher","award":["KL2TR00234"],"award-info":[{"award-number":["KL2TR00234"]}],"id":[{"id":"10.13039\/100006108","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100006108","name":"National Center for Advancing Translational Sciences","doi-asserted-by":"publisher","award":["UL1TR002345"],"award-info":[{"award-number":["UL1TR002345"]}],"id":[{"id":"10.13039\/100006108","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100006108","name":"National Center for Advancing Translational Sciences","doi-asserted-by":"publisher","award":["K23MH142221"],"award-info":[{"award-number":["K23MH142221"]}],"id":[{"id":"10.13039\/100006108","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100006108","name":"National Center for Advancing Translational Sciences","doi-asserted-by":"publisher","award":["K24AI134413"],"award-info":[{"award-number":["K24AI134413"]}],"id":[{"id":"10.13039\/100006108","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,8,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Advancing the HIV response in Missouri, an Ending the HIV Epidemic priority state, requires stronger characterization of treatment gaps. Routine cross-sectional reporting may fail to capture important gaps in care that longitudinal methods can reveal.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We characterized clinic engagement and viral suppression among people with Human Immunodeficiency Virus (HIV) aged \u226518 years who were newly linked to clinic in St Louis, Missouri, between 1 January 2015 and 15 March 2020. Using multistate analytic methods that capture change over time, we estimated the prevalence of individuals in 9 mutually exclusive and exhaustive states over 3 years following linkage to clinic. Care states were based on engagement (disengagement \u226590 days late for a scheduled appointment) and viral load status (suppression defined as viral load &amp;lt;200\u2005copies\/mL \u2264200 days).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Overall 1110 patients were newly linked to clinic during the observation period, contributing 2255.4 person-years of follow-up. One year following linkage, 54.8% (95% CI, 51.6%\u201357.9%) were continuously retained, 15.2% (95% CI, 13.0%\u201317.7%) were reengaged, and 29.3% (95% CI, 26.6%\u201332.2%) were disengaged. In addition, 93.0% (95% CI, 90.6%\u201395.1%) of continuously retained individuals were virally suppressed at 1 year as compared with 81.6% (95% CI, 75.2%\u201387.7%) of reengaged individuals. Younger individuals and those from historically marginalized communities were more likely to disengage, reengage, and become viremic.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Multistate methods revealed a pattern of disengagement from clinic and reengagement, accompanied by elevated risk of viremia during disengagement. Shifting retention efforts from preventing isolated missed visits toward supporting sustained, long-term engagement in care is a key priority.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/ofid\/ofag414","type":"journal-article","created":{"date-parts":[[2026,7,14]],"date-time":"2026-07-14T11:37:11Z","timestamp":1784029031000},"source":"Crossref","is-referenced-by-count":0,"title":["A Multistate Analysis of Longitudinal Care Outcomes Among People Newly Linked to Human Immunodeficiency Virus Care in Missouri"],"prefix":"10.1093","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0843-1414","authenticated-orcid":false,"given":"Aditi","family":"Ramakrishnan","sequence":"first","affiliation":[{"name":"Division of Infectious Diseases, Department of Medicine, Washington University School of Medicine , St Louis, Missouri 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G","family":"Powderly","sequence":"additional","affiliation":[{"name":"Division of Infectious Diseases, Department of Medicine, Washington University School of Medicine , St Louis, Missouri ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9922-9208","authenticated-orcid":false,"given":"Anne","family":"Trolard","sequence":"additional","affiliation":[{"name":"Washington University School of Medicine , St Louis, Missouri ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Corey","family":"Grejtak-Heaps","sequence":"additional","affiliation":[{"name":"Division of Infectious Diseases, Department of Medicine, Washington University School of Medicine , St Louis, Missouri ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elvin H","family":"Geng","sequence":"additional","affiliation":[{"name":"Division of Infectious Diseases, Department of Medicine, Washington University School of Medicine , St Louis, Missouri ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3787-365X","authenticated-orcid":false,"given":"Aaloke","family":"Mody","sequence":"additional","affiliation":[{"name":"Division of Infectious Diseases, Department of Medicine, Washington University School of Medicine , St Louis, Missouri ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lindsey M","family":"Filiatreau","sequence":"additional","affiliation":[{"name":"Bursky School of Public Health , Washington University in St Louis, St Louis, Missouri ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2026,8,6]]},"reference":[{"key":"2026080609015025300_ofag414-B1","author":"Division of HIV\/AIDS 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