Abstract
Competing priorities between subsistence needs and health care may interfere with HIV health. Longitudinal data from the Los Angeles-based HIV Outreach Initiative were analyzed to examine the association between competing subsistence needs and indicators of poor retention-in-care among hard-to-reach people with HIV. Sacrificing basic needs for health care in the previous six months was associated with a 1.55 times greater incidence of missed appointments (95% CI 1.17, 2.05), 2.32 times greater incidence of emergency department visits (95% CI 1.39, 3.87), 3.66 times greater incidence of not receiving ART if CD4 < 350 (95% CI 1.60, 8.37), and 1.35 times greater incidence of detectable viral load (95% CI 1.07, 1.70) (all p < 0.01). Among hard-to-reach PLHIV, sacrificing basic needs for health care delineates a population with exceptional vulnerability to poor outcomes along the HIV treatment cascade. Efforts to identify and reduce competing needs for this population are crucial to HIV health outcomes.