# Retaining relevance: extending clinical retention measures to improve their utility in describing HIV care engagement in the United States

> **NIH NIH R01** · VANDERBILT UNIVERSITY MEDICAL CENTER · 2024 · $630,091

## Abstract

Project Summary / Abstract
 HIV remains a major public health concern in the United States. The proportions of people with HIV (PWH)
in 2020 who knew their HIV status, were linked to care, retained in clinical care (50%), and had suppressed
viral loads (57%), were lackluster. Retention in clinical care is a core quality-of-care indicator and the central
stage of the HIV care continuum. Suboptimal clinical retention is strongly associated with virologic failure while
on ART, high-risk behavior, and poorer survival. Furthermore, it is estimated that 43% of new HIV
transmissions are from PWH who are out of care (the largest proportion from any one care continuum stage).
The implication, echoed in multiple public health policies over the past decade, is that high retention and
engagement in clinical care are critical for blunting the HIV-related morbidity and mortality and reducing the
number of new HIV infections.
 However, despite consensus that “retention” in care is critical and “engagement” in care must be increased,
we do not fully understand how best to measure retention and engagement among patients in high-income
settings, particularly in the modern ART era and given changes in care delivery that were introduced during the
COVID-19 pandemic. Earlier research indicated that sicker patients (i.e., those with lower CD4) were more
likely to miss clinic visits. More recent work, though, found that patients attending clinic visits less frequently
may continue to receive laboratory monitoring services; this could well be an indication that healthier patients
(i.e., those with higher CD4) who are stably virally suppressed are compliant with newer monitoring guidelines
which demand less frequent clinic visits. However, the field has yet to delineate the optimal frequency of clinic
visits for these healthier, virally suppressed patients as opposed to individuals in multiple other risk strata,
though applying a single metric regardless of sub-population could produce spurious findings of poor retention
among clinically stable individuals. In this respect, our proposal is truly novel.
 The proposed research will therefore extract, harmonize, and analyze readily available data on clinical care
patterns within the largest HIV cohort in North America: the North American AIDS Cohort Collaboration on
Research and Design. We will use these data to describe patterns of retention and engagement (Aim 1),
isolate multiple measures of care receipt (Aims 1 and 2) that predict improved survival and viral suppression,
and assess multiple methods for stratifying populations while quantifying the expected causal impact of
improved retention on HIV outcomes under existing and novel, optimized metrics (Aim 3). The public health
impact of improved retention metrics, based on population-specific HIV clinical care engagement, would be
profound, particularly in light of changes in HIV disease and comorbidity clinical management and laboratory
monitoring under a primary care ...

## Key facts

- **NIH application ID:** 10891712
- **Project number:** 5R01AI177010-02
- **Recipient organization:** VANDERBILT UNIVERSITY MEDICAL CENTER
- **Principal Investigator:** Keri Nicole Althoff
- **Activity code:** R01 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2024
- **Award amount:** $630,091
- **Award type:** 5
- **Project period:** 2023-07-20 → 2028-06-30

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10891712

## Citation

> US National Institutes of Health, RePORTER application 10891712, Retaining relevance: extending clinical retention measures to improve their utility in describing HIV care engagement in the United States (5R01AI177010-02). Retrieved via AI Analytics 2026-05-22 from https://api.ai-analytics.org/grant/nih/10891712. Licensed CC0.

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