Examining the Effects of Retention in HIV care and Presence of Depression on Sustained Viral Suppression: A Retrospective Cohort Study 2003 - 2011

The purpose of this study was to examine the effects of retention in care and the presence of depression on sustained viral suppression over time. A retrospective cohort study was conducted among patients who sought care at the clinic between 2003 and 2011 and were virally suppressed (<400 copies/ml) at least once during the study. Retention in care was defined as having at least two HIV medical care visits separated by ≥3 months during a 12-month period. A generalized linear mixed model was employed to determine the predictors that affect viral suppression over time.  A total of 667 patients were included in the study and the mean follow-up time for the study participants was 6.14±2.50 years. A total of 278 (42%) patients were diagnosed with depression and were more likely to be white, on Medicare, MSM, and have a history of drug abuse. Over the nine-year study period, the average rate of retention was 81%±29.3%, with 60% being optimally retained in care. In the mixed model, the presence of depression was associated with worse sustained suppression over time (Odds Ratio (OR): 0.42; 95% Confidence Interval (CI): 0.24-0.74). Having poor retention over time was also associated with worse sustained suppression over time (OR: 0.35; 95% CI: 0.19-0.60). Patients with poor retention and mental health problems have a much harder time maintaining suppression which increases their risk of HIV transmission, and poor health outcomes. Interventions are needed to target those with depression as well as those with poor retention in care.