• People with HIV who were out-of-care were more likely to be Black, young, and to report poorer health status than those in-care. They were also more likely to be uninsured, experience changes in their usual source of care related to insurance changes, and were less likely to have a regular provider or to receive support from the Ryan White Program. There were no statistically significant differences based on state Medicaid expansion status or census region.
 
• Those out-of-care were more likely to report barriers to care engagement, including in the areas of finances, mental health, and getting to a doctor’s office, as well as more dissatisfaction with care than those in-care. They were also more likely to report unmet needs for ancillary social and support services in three domains: clinical, non-HIV medical/behavioral, and subsistence services, with more than half reporting at least one unmet need.
 
• Whereas virtually all people with HIV in-care were on antiretroviral therapy, a fifth of those out-of- care were not on ARVs, and among those who were, they were more likely to report missing treatment doses. In addition, smaller shares reported being familiar with the concept of treatment as prevention (TasP) than those in-care, though there were substantial knowledge gaps for both groups.
 
• Identifying people with HIV who are out-of-care, and better understanding the barriers they face, are first steps towards engaging or reengaging them in-care, addressing their unmet needs, and improving their health status. Doing so could play a role in advancing the goals in the national HIV/AIDS Strategy and the federal Ending the HIV initiative.