Speaker Kathleen Clanon

2. Continuum Engagement in Care Not in Care Fully Engaged Non-engager Sporadic User Fully Engaged Health Resources Service Administration (HRSA) Unaware of HIV Status (not tested or never received results) Know HIV Status (not referred to care; didn ’ t keep referral) May Be Receiving Other Medical Care But Not HIV Care Entered HIV Primary Medical Care But Dropped Out (lost to follow-up) In and Out of HIV Care or Infrequent User Fully Engaged in HIV Primary Medical Care

3. Why Is Retention Important for People Living with HIV? Population Appointments Health Outcome 123 patients, primary care clinic, (Rastegar, 2003) Baltimore Not specified which appts. included Associated with VL> 500 copies/ml 273 patients, large urban clinic in Baltimore (Lucas, 1999) Nursing, psychiatry, dermatology, neurology and gastroenterology Associated with failure to suppress VL 195 patients, JHU outpatients center (Sethi, 2003) “ Scheduled clinic visit” Associated with viral rebound and clinically significant resistance 366 patients, HIV clinic in Cleveland (Valdez, 1999) “ Clinic visit” Missing <2 appts. associated lower VL (<400 copies/mL)

9. Evidence Base for Strategies to Connect Patients to Care

15. Small Group Work: Solution Fish What Ideas Can We Try for Improvement ?