Routine HIV clinic visit adherence in the African Cohort Study

AIDS Research and Therapy

Hannah Kibuuka¹  Julie A. Ake²  Michael Iroezindu³  John Owuoth⁴  Emmanuel Bahemana⁵  Nicole Dear⁶  Trevor A. Crowell⁶  Allahna Esber⁶  Christina S. Polyak⁶  Jonah Maswai⁷ 

[1] Makerere University Walter Reed Project, Kampala, Uganda;U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, MD, USA;U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, MD, USA;HJF Medical Research International, Abuja, Nigeria;U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, MD, USA;HJF Medical Research International, Kisumu, Kenya;U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, MD, USA;HJF Medical Research International, Mbeya, Tanzania;U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, MD, USA;Henry M. Jackson Foundation for the Advancement of Military Medicine, 6720A Rockledge Dr, Suite 400, 20817, Bethesda, MD, USA;U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, MD, USA;U.S. Army Medical Research Directorate - Africa, Kericho, Kenya;

关键词: HIV;    East Africa;    West Africa;    Clinic visits;    Patient engagement;    Care retention;   

DOI  :  10.1186/s12981-021-00425-0

来源: Springer

【 摘 要 】

BackgroundRetention in clinical care is important for people living with HIV (PLWH). Evidence suggests that missed clinic visits are associated with interruptions in antiretroviral therapy (ART), lower CD4 counts, virologic failure, and overlooked coinfections. We identified factors associated with missed routine clinic visits in the African Cohort Study (AFRICOS).MethodsIn 2013, AFRICOS began enrolling people with and without HIV in Uganda, Kenya, Tanzania, and Nigeria. At enrollment and every 6 months thereafter, sociodemographic questionnaires are administered and clinical outcomes assessed. Missed clinic visits were measured as the self-reported number of clinic visits missed in the past 6 months and dichotomized into none or one or more visits missed. Logistic regression with generalized estimating equations was used to estimate odds ratios (ORs) and 95% confidence intervals (CIs) for associations between risk factors and missed visits.ResultsBetween January 2013 and March 2020, 2937 PLWH were enrolled, of whom 2807 (95.6%) had initiated ART and 2771 had complete data available for analyses. Compared to PLWH 50+, missed clinic visits were more common among those 18–29 years (aOR 2.33, 95% CI 1.65–3.29), 30–39 years (aOR 1.59, 95% CI 1.19–2.13), and 40–49 years (aOR 1.42, 95% CI 1.07–1.89). As compared to PLWH on ART for < 2 years, those on ART for 4+ years were less likely to have missed clinic visits (aOR 0.72, 95% CI 0.55–0.95). Missed clinic visits were associated with alcohol use (aOR 1.34, 95% CI 1.05–1.70), a history of incarceration (aOR 1.42, 95% CI 1.07–1.88), depression (aOR 1.47, 95% CI 1.13–1.91), and viral non-suppression (aOR 2.50, 95% CI 2.00–3.12). As compared to PLWH who did not miss any ART in the past month, missed clinic visits were more common among those who missed 1–2 days (aOR 2.09, 95% CI 1.65–2.64) and 3+ days of ART (aOR 7.06, 95% CI 5.43–9.19).ConclusionsInconsistent clinic attendance is associated with worsened HIV-related outcomes. Strategies to improve visit adherence are especially needed for young PLWH and those with depression.

【 授权许可】

CC BY