{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,21]],"date-time":"2026-02-21T07:16:23Z","timestamp":1771658183233,"version":"3.50.1"},"reference-count":50,"publisher":"Public Library of Science (PLoS)","issue":"12","license":[{"start":{"date-parts":[[2020,12,29]],"date-time":"2020-12-29T00:00:00Z","timestamp":1609200000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"<jats:sec id=\"sec001\">\n<jats:title>Objectives<\/jats:title>\n<jats:p>To determine rates of annual and durable retention in medical care and viral suppression among patients enrolled in the Peter Ho Clinic, from 2013\u20132017.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec002\">\n<jats:title>Methods<\/jats:title>\n<jats:p>This is a retrospective review of medical record data in an urban clinic, located in Newark, New Jersey, a high prevalence area of persons living with HIV. Viral load data were electronically downloaded, in rolling 1-year intervals, in two-month increments, from January 1, 2013 to December 31, 2019. Three teams were established, and every two months, they were provided with an updated list of patients with virologic failure. Retention and viral suppression rates were first calculated for each calendar-year. After patients were determined to be retained\/suppressed annually, the proportion of patients with durable retention and viral suppression were calculated in two, three, four, five and six-year periods. Descriptive statistics were used to summarize sample characteristics by retention in care, virologic failure and viral suppression with Pearson Chi-square; p-value &lt;0.05 was statistically significant. Multiple logistic regression models identified patient characteristics associated with retention in medical care, virologic failure and suppression.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec003\">\n<jats:title>Results<\/jats:title>\n<jats:p>As of December 31, 2017, 1000 (57%) patients were retained in medical care of whom 870 (87%) were suppressed. Between 2013 and 2016, decreases in annual (85% to 77%) and durable retention in care were noted: two-year (72% to 70%) and three-year (63% to 59%) periods. However, increases were noted for 2017, in annual (89%) and durable retention in the two-year period (79%). In the adjusted model, when compared to current patients, retention in care was less likely among patients reengaging in medical care (adjusted Odds Ratio (aOR): 0.77, 95% CI: 0.61\u20130.98) but more likely among those newly diagnosed from 2014\u20132017 (aOR: 1.57, 95% CI: 1.08\u20132.29), compared to those in care since 2013. A higher proportion of patients re-engaging in medical care had virologic failure than current patients (56% vs. 47%, p &lt; 0.0001). As age decreased, virologic failure was more likely (p&lt;0.0001). Between 2013 and 2017, increases in annual (74% to 87%) and durable viral suppression were noted: two-year (59% to 73%) and three-year (49% to 58%) periods. Viral suppression was more likely among patients retained in medical care up to 2017 versus those who were not (aOR: 5.52, 95% CI: 4.08\u20137.46). Those less likely to be suppressed were 20\u201329 vs. 60 years or older (aOR: 0.52, 95% CI: 0.28\u20130.97), had public vs. private insurance (aOR: 0.29, 95% CI: 0.15\u20130.55) and public vs. private housing (aOR: 0.59, 95% CI: 0.40\u20130.87).<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec004\">\n<jats:title>Conclusions<\/jats:title>\n<jats:p>Restructuring clinical services at this urban clinic was associated with improved viral suppression. However, concurrent interventions to ensure retention in medical care were not implemented. Both retention in care and viral suppression interventions should be implemented in tandem to achieve an end to the epidemic. Retention in care and viral suppression should be measured longitudinally, instead of cross-sectional yearly evaluations, to capture dynamic changes in these indicators.<\/jats:p>\n<\/jats:sec>","DOI":"10.1371\/journal.pone.0244376","type":"journal-article","created":{"date-parts":[[2020,12,29]],"date-time":"2020-12-29T19:02:23Z","timestamp":1609268543000},"page":"e0244376","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":7,"title":["Annual and durable HIV retention in care and viral suppression among patients of Peter Ho Clinic, 2013-2017"],"prefix":"10.1371","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0229-2425","authenticated-orcid":true,"given":"Debbie Y.","family":"Mohammed","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lisa Marie","family":"Koumoulos","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Eugene","family":"Martin","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jihad","family":"Slim","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"340","published-online":{"date-parts":[[2020,12,29]]},"reference":[{"key":"pone.0244376.ref001","unstructured":"Centers for Disease Control and Prevention. HIV Surveillance Report, 2018 (Updated); vol. 31. Available from: http:\/\/www.cdc.gov\/hiv\/library\/reports\/hiv-surveillance.html"},{"key":"pone.0244376.ref002","unstructured":"New Jersey Department of Health [Internet]. Newark (NJ): County and Municipal HIV\/AIDS Statistics, 2018; [cited 2020 Aug 5]. Available from: https:\/\/www.state.nj.us\/health\/hivstdtb\/hiv-aids\/statmap.shtml"},{"key":"pone.0244376.ref003","unstructured":"New Jersey Department of Health [Internet]. Newark (NJ): Top ten cities with the highest numbers of cases; [cited 2020 Aug 5]. Available from: https:\/\/www.state.nj.us\/health\/hivstdtb\/hiv-aids\/cities.shtml"},{"key":"pone.0244376.ref004","doi-asserted-by":"crossref","first-page":"17","DOI":"10.7326\/0003-4819-135-1-200107030-00005","article-title":"Viral Activation Transfusion Study Investigators. Highly active antiretroviral therapy decreases mortality and morbidity in patients with advanced HIV disease","volume":"135","author":"EL Murphy","year":"2001","journal-title":"Ann Intern Med"},{"issue":"1","key":"pone.0244376.ref005","doi-asserted-by":"crossref","first-page":"140","DOI":"10.1093\/ije\/dyv352","article-title":"The effect of antiretroviral therapy on all-cause mortality, generalized to persons diagnosed with HIV in the USA, 2009\u201311","volume":"45","author":"CNICS Investigators","year":"2016","journal-title":"Int J Epidemiol"},{"key":"pone.0244376.ref006","doi-asserted-by":"crossref","first-page":"230","DOI":"10.1097\/QAI.0000000000000960","article-title":"Population-based estimates of life expectancy after HIV diagnosis: United States 2008\u20132011","volume":"72","author":"AE Siddiqi","year":"2016","journal-title":"J Acquir Immune Defic Syndr"},{"issue":"9","key":"pone.0244376.ref007","doi-asserted-by":"crossref","first-page":"830","DOI":"10.1056\/NEJMoa1600693","article-title":"HPTN 052 Study Team. Antiretroviral therapy for the prevention of HIV-1 transmission","volume":"375","author":"MS Cohen","year":"2016","journal-title":"N Engl J Med"},{"key":"pone.0244376.ref008","unstructured":"Centers for Disease Control and Prevention. Monitoring selected national HIV prevention and care objectives by using HIV surveillance data\u2014United States and 6 dependent areas, 2014. HIV Surveillance Supplemental Report 2016;21(4). Available from: https:\/\/www.cdc.gov\/hiv\/pdf\/library\/reports\/surveillance\/cdc-hiv-surveillance-supplemental-report-vol-21-4.pdf"},{"issue":"5","key":"pone.0244376.ref009","doi-asserted-by":"crossref","first-page":"279","DOI":"10.1089\/apc.2014.0346","article-title":"Barriers to HIV care and treatment among participants in a public health HIV care relinkage program","volume":"29","author":"JC Dombrowski","year":"2015","journal-title":"AIDS patient care STDS"},{"issue":"3","key":"pone.0244376.ref010","doi-asserted-by":"crossref","first-page":"307","DOI":"10.1097\/QAI.0000000000001078","article-title":"Impact of health insurance, ADAP, and income on HIV viral suppression among US women in the women's interagency HIV study, 2006\u20132009","volume":"73","author":"C Ludema","year":"1999","journal-title":"J Acquir Immune Defic Syndr"},{"issue":"5","key":"pone.0244376.ref011","doi-asserted-by":"crossref","first-page":"892","DOI":"10.1007\/s40615-019-00589-6","article-title":"Exploring social determinants of health as predictors of mortality during 2012\u20132016, among black women with diagnosed HIV infection attributed to heterosexual contact, United States","volume":"6","author":"L Watson","year":"2019","journal-title":"Racial Ethn Health Disparities"},{"issue":"1","key":"pone.0244376.ref012","doi-asserted-by":"crossref","DOI":"10.2105\/AJPH.2015.302905a","article-title":"Housing status, medical care, and health outcomes among people living with HIV\/AIDS: a systematic review","volume":"106","author":"AA Aidala","year":"2016","journal-title":"Am J Public Health"},{"issue":"1","key":"pone.0244376.ref013","doi-asserted-by":"crossref","first-page":"e29679","DOI":"10.1371\/journal.pone.0029679","article-title":"Novel use of surveillance data to detect HIV-infected persons with sustained high viral load and durable virologic suppression in New York City","volume":"7","author":"AS Terzian","year":"2012","journal-title":"PloS one"},{"issue":"4","key":"pone.0244376.ref014","doi-asserted-by":"crossref","first-page":"1016","DOI":"10.1007\/s10461-016-1585-5","article-title":"Retention, antiretroviral therapy use and viral suppression by history of injection drug use among HIV-infected patients in an urban HIV clinical cohort","volume":"21","author":"CR Lesko","year":"2017","journal-title":"AIDS Behav"},{"key":"pone.0244376.ref015","unstructured":"The White House Office of National AIDS Policy (2010) National HIV\/AIDS Strategy for the United States. Available from: https:\/\/obamawhitehouse.archives.gov\/sites\/default\/files\/uploads\/NHAS.pdf"},{"key":"pone.0244376.ref016","unstructured":"The White House Office of National AIDS Policy. National HIV\/AIDS strategy: updated to 2020. Available from: https:\/\/www.hiv.gov\/federal-response\/national-hiv-aids-strategy\/nhas-update"},{"key":"pone.0244376.ref017","unstructured":"Health Resources and Services Administration: HIV\/AIDS Bureau. Performance measure portfolio, core measures, 2019. Available from: https:\/\/hab.hrsa.gov\/sites\/default\/files\/hab\/clinical-quality-management\/coremeasures.pdf"},{"issue":"5","key":"pone.0244376.ref018","doi-asserted-by":"crossref","first-page":"648","DOI":"10.1093\/cid\/civ941","article-title":"Continuous retention and viral suppression provide further insights into the HIV care continuum compared to the cross-sectional HIV care cascade","volume":"62","author":"J Colasanti","year":"2016","journal-title":"Clin Infect Dis"},{"issue":"7","key":"pone.0244376.ref019","doi-asserted-by":"crossref","first-page":"976","DOI":"10.1093\/cid\/ciw418","article-title":"Durable viral suppression and transmission risk potential among persons with diagnosed HIV infection: United States, 2012\u20132013","volume":"63","author":"N Crepaz","year":"2016","journal-title":"Clin Infect Dis"},{"issue":"4","key":"pone.0244376.ref020","doi-asserted-by":"crossref","first-page":"594","DOI":"10.1007\/s10461-014-0917-6","article-title":"True durability: HIV virologic suppression in an urban clinic and implications for timing of intensive adherence efforts and viral load monitoring","volume":"19","author":"DA Benator","year":"2015","journal-title":"AIDS Behav"},{"issue":"6","key":"pone.0244376.ref021","doi-asserted-by":"crossref","first-page":"e0129376","DOI":"10.1371\/journal.pone.0129376","article-title":"HIV Research Network. The HIV care continuum: changes over time in retention in care and viral suppression","volume":"10","author":"BR Yehia","year":"2015","journal-title":"PloS one"},{"issue":"1","key":"pone.0244376.ref022","doi-asserted-by":"crossref","first-page":"42","DOI":"10.1177\/2325957416678929","article-title":"Retention in continuous care and sustained viral suppression","volume":"16","author":"TN Crawford","year":"2017","journal-title":"J Int Assoc Provid AIDS Care"},{"issue":"1","key":"pone.0244376.ref023","doi-asserted-by":"crossref","first-page":"46","DOI":"10.1097\/QAI.0000000000001877","article-title":"Impact of an HIV care coordination program on durable viral suppression","volume":"80","author":"MM Robertson","year":"2019","journal-title":"J Acquir Immune Defic Syndr"},{"key":"pone.0244376.ref024","doi-asserted-by":"crossref","first-page":"14","DOI":"10.1186\/1742-6405-7-14","article-title":"Outcomes of highly active antiretroviral therapy in the context of universal access to healthcare: the U.S. Military HIV Natural History Study","volume":"7","author":"VC Marconi","year":"2010","journal-title":"AIDS Res Ther"},{"key":"pone.0244376.ref025","doi-asserted-by":"crossref","first-page":"351","DOI":"10.1186\/s12879-016-1677-x","article-title":"Factors associated with 10 years of continuous viral load suppression on HAART","volume":"16","author":"KJ Bello","year":"2016","journal-title":"BMC Infect Dis"},{"key":"pone.0244376.ref026","unstructured":"United States Department of Health and Human Services. Guidelines for the use of antiretroviral therapy in adults and adolescents; Laboratory Testing, 2019. Available from: https:\/\/aidsinfo.nih.gov\/guidelines\/html\/1\/adult-and-adolescent-arv\/458\/plasma-hiv-1-rna\u2014viral-load\u2014and-cd4-count-monitoring"},{"key":"pone.0244376.ref027","doi-asserted-by":"crossref","first-page":"400","DOI":"10.1016\/S0033-3549(04)50271-6","article-title":"Classification of transmission risk in the National HIV\/AIDS Surveillance System","volume":"118","author":"L Lee","year":"2003","journal-title":"Public Health Reports"},{"key":"pone.0244376.ref028","unstructured":"United States Department of Health and Human Services. 2017 Poverty Guidelines. Available from: https:\/\/aspe.hhs.gov\/2017-poverty-guidelines"},{"issue":"9","key":"pone.0244376.ref029","doi-asserted-by":"crossref","first-page":"2532","DOI":"10.1007\/s10461-019-02450-7","article-title":"HIV care trajectories as a novel longitudinal assessment of retention in are","volume":"23","author":"EA Enns","year":"2019","journal-title":"AIDS Behav"},{"key":"pone.0244376.ref030","doi-asserted-by":"crossref","first-page":"117","DOI":"10.1093\/cid\/ciu722","article-title":"High rates of retention and viral suppression in United States HIV safety net system: HIV care continuum in the Ryan White HIV\/AIDS Program, 2011","volume":"60","author":"RK Doshi","year":"2014","journal-title":"Clin Infect Dis"},{"issue":"1","key":"pone.0244376.ref031","doi-asserted-by":"crossref","first-page":"82","DOI":"10.1097\/QAI.0000000000001469","article-title":"HIV Research Network. Assessing antiretroviral use during gaps in HIV primary care using multisite Medicaid claims and clinical data","volume":"76","author":"AK Monroe","year":"2017","journal-title":"J Acquir Immune Defic Syndr. (1999)"},{"issue":"2","key":"pone.0244376.ref032","doi-asserted-by":"crossref","first-page":"205","DOI":"10.1097\/QAI.0000000000001036","article-title":"Single viral load measurements overestimate stable viral suppression among HIV patients in care: clinical and public health implications","volume":"73","author":"G Marks","year":"2016","journal-title":"J Acquir Immune Defic Syndr"},{"issue":"17","key":"pone.0244376.ref033","doi-asserted-by":"crossref","first-page":"2421","DOI":"10.1097\/QAD.0000000000001660","article-title":"Changes in viral suppression status among US HIV-infected patients receiving care","volume":"31","author":"N Crepaz","year":"2017","journal-title":"AIDS"},{"issue":"Suppl 2","key":"pone.0244376.ref034","doi-asserted-by":"crossref","first-page":"S88","DOI":"10.1097\/QAI.0000000000001234","article-title":"Longitudinal HIV care trajectories in North Carolina","volume":"74","author":"KA Powers","year":"2017","journal-title":"J Acquir Immune Defic Syndr"},{"issue":"4","key":"pone.0244376.ref035","doi-asserted-by":"crossref","first-page":"413","DOI":"10.1097\/QAI.0000000000000489","article-title":"North American AIDS Cohort Collaboration on Research and Design (NA-ACCORD). Impact of age on retention in care and viral suppression","volume":"68","author":"BR Yehia","year":"2015","journal-title":"J Acquir Immune Defic Syndr"},{"issue":"10","key":"pone.0244376.ref036","doi-asserted-by":"crossref","first-page":"1027","DOI":"10.1089\/aid.2017.0016","article-title":"Trends in HIV Continuum of Care Outcomes over Ten Years of Follow-Up at a Large HIV Primary Medical Home in the Southeastern United States","volume":"33","author":"MK Ghiam","year":"2017","journal-title":"AIDS Res Hum Retroviruses"},{"key":"#cr-split#-pone.0244376.ref037.1","unstructured":"Cohen S. HRSA's Ryan White HIV\/AIDS Program: A Critical Component to Ending the HIV Epidemic. In: American Public Health Association Annual Meeting, 2020, Oct 24-28"},{"key":"#cr-split#-pone.0244376.ref037.2","unstructured":"Virtual. [cited 2020 Nov 1] Available from: https:\/\/apha.confex.com\/apha\/2020\/meetingapp.cgi\/Session\/61686"},{"issue":"7","key":"pone.0244376.ref038","doi-asserted-by":"crossref","first-page":"1068","DOI":"10.2105\/AJPH.2020.305660","article-title":"Enrollment length, service category, and HIV health outcomes among low-income HIV-positive persons newly enrolled in a housing program, New York City, 2014\u20132017","volume":"110","author":"Y Zhong","year":"2020","journal-title":"American Journal of Public Health"},{"issue":"3","key":"pone.0244376.ref039","doi-asserted-by":"crossref","first-page":"784","DOI":"10.1007\/s10461-019-02399-7","article-title":"Multilevel Factors Associated with a Lack of Viral Suppression Among Persons Living with HIV in a Federally Funded Housing Program","volume":"23","author":"CM Beattie","year":"2019","journal-title":"AIDS Behav"},{"key":"pone.0244376.ref040","unstructured":"United States Department of Health and Human Services (2010). Compilation of patient protection and affordable care act. Available from: http:\/\/www.hhs.gov\/healthcare\/about-the-law\/read-the-law\/index.html Accessed on August 9, 2020"},{"key":"pone.0244376.ref041","unstructured":"New Jersey Department of Health (2020) Charity Care\u2014New Jersey Hospital Care Payment Assistance Program. Available from: https:\/\/www.nj.gov\/health\/charitycare\/documents\/NJ%20Charity%20Care%20Fact%20Sheet_Feb2018%20(English).pdf"},{"issue":"3","key":"pone.0244376.ref042","doi-asserted-by":"crossref","first-page":"404","DOI":"10.1093\/cid\/ciw280","article-title":"Editorial commentary: Affordable Care Act, Medicaid expansion \u2026 or not: Ryan White Care Act remains essential for access and equity","volume":"63","author":"EF Eaton","year":"2016","journal-title":"Clin Infect Dis"},{"issue":"6","key":"pone.0244376.ref043","doi-asserted-by":"crossref","first-page":"731","DOI":"10.1080\/09540121.2013.855299","article-title":"Interdisciplinary HIV care in a changing healthcare environment in the USA","volume":"26","author":"B Ojikutu","year":"2014","journal-title":"AIDS Care"},{"issue":"1","key":"pone.0244376.ref044","doi-asserted-by":"crossref","first-page":"90","DOI":"10.1093\/cid\/civ708","article-title":"Ryan White HIV\/AIDS program assistance and HIV treatment outcomes","volume":"62","author":"H Bradley","year":"2016","journal-title":"Clin Infect Dis"},{"issue":"S4","key":"pone.0244376.ref045","doi-asserted-by":"crossref","first-page":"S246","DOI":"10.2105\/AJPH.2018.304689","article-title":"Reducing HIV-related health disparities in the Health Resources and Services Administration's Ryan White HIV\/AIDS Program","volume":"108","author":"P Mandsager","year":"2018","journal-title":"Am J Public Health"},{"key":"pone.0244376.ref046","doi-asserted-by":"crossref","first-page":"3091","DOI":"10.1007\/s10461-018-2124-3","article-title":"The impact of the Ryan White HIV\/AIDS Medical Case Management Program on HIV Clinical Outcomes: a longitudinal study","volume":"22","author":"JD L\u00f3pez","year":"2018","journal-title":"AIDS Behav"},{"issue":"1","key":"pone.0244376.ref047","doi-asserted-by":"crossref","first-page":"89","DOI":"10.1080\/09540121.2019.1623375","article-title":"Ryan White HIV\/AIDS program recipients more likely than non-recipients to be retained in care using six different retention measures","volume":"32","author":"ES Kay","year":"2020","journal-title":"AIDS Care"},{"issue":"11","key":"pone.0244376.ref048","doi-asserted-by":"crossref","first-page":"582","DOI":"10.1089\/apc.2015.0139","article-title":"The HIV care cascade measured over time and by age, sex, and race in a large national integrated care system","volume":"29","author":"MA Horberg","year":"2015","journal-title":"AIDS Patient Care and STDS"},{"issue":"9","key":"pone.0244376.ref049","doi-asserted-by":"crossref","first-page":"844","DOI":"10.1001\/jama.2019.1343","article-title":"Ending the HIV epidemic: A plan for the United States","volume":"321","author":"AS Fauci","year":"2019","journal-title":"JAMA"}],"container-title":["PLOS ONE"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0244376","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2020,12,29]],"date-time":"2020-12-29T19:03:03Z","timestamp":1609268583000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0244376"}},"subtitle":[],"editor":[{"given":"Ellen","family":"Wiewel","sequence":"first","affiliation":[],"role":[{"role":"editor","vocabulary":"crossref"}]}],"short-title":[],"issued":{"date-parts":[[2020,12,29]]},"references-count":50,"journal-issue":{"issue":"12","published-online":{"date-parts":[[2020,12,29]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pone.0244376","relation":{},"ISSN":["1932-6203"],"issn-type":[{"value":"1932-6203","type":"electronic"}],"subject":[],"published":{"date-parts":[[2020,12,29]]}}}