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Pain is Associated with Missed Clinic Visits Among HIV-Positive Women

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Abstract

Pain is highly prevalent among HIV-positive individuals, with women representing a large subset of those with pain. However, little is known about the relationship between pain and retention in HIV medical care. Among a cohort of HIV-positive women of color, we evaluated the association between pain and retention in care, as measured by missed clinic visits. The Health Resources and Services Administration’s Women of Color Initiative was a multi-site observational cohort study evaluating demonstration projects to engage HIV-positive women in medical care. From November 2010 to July 2013, 921 women were enrolled in the study across nine U.S. sites; baseline interviews collected data on socio-demographic, clinical, and risk behavior characteristics. Pain was assessed at baseline based on number of days in pain over the last 30 days and was categorized as no pain (0 days), infrequent pain (1–13 days), and frequent pain (14–30 days), with 14 days being the median. Missed visits over the one-year follow-up period, evaluated by chart abstraction, were dichotomized as ≤1 missed visit versus >1 missed visit. We conducted multivariate logistic regression to assess the association between pain at baseline and missed visits, adjusting for pertinent covariates. Among our sample (N = 862), 52.2 % of women reported no pain, 23.7 % reported infrequent pain and 24.1 % reported frequent pain. Forty-five percent had >1 missed visit during the one-year follow-up period. Overall, we did not find a significant association between pain and missed visits (aOR 2.30; 95 % CI 1.00–5.25). However, in planned stratified analyses, among women reporting current substance use at baseline, reporting frequent pain was associated with a higher odds of missed visits as compared with reporting no pain (aOR 15.14; 95 % CI 1.78–128.88). In our overall sample, pain was not significantly associated with missed visits. However, frequent pain was associated with missed visits among HIV-positive women of color who reported substance use at baseline. A better understanding of the relationship between pain and missed visits could guide efforts to improve retention in care in this population.

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References

  1. Miaskowski C, Penko JM, Guzman D, Mattson JE, Bangsberg DR, Kushel MB. Occurrence and characteristics of chronic pain in a community-based cohort of indigent adults living with HIV infection. J Pain. 2011;12:1004–16.

    Article  PubMed  PubMed Central  Google Scholar 

  2. Parker R, Stein DJ, Jelsma J. Pain in people living with HIV/AIDS: a systematic review. Journal of the International AIDS Society 2014;17.

  3. Breitbart W, Rosenfeld B, Passik S, Kaim M, Funesti-Esch J, Stein K. A comparison of pain report and adequacy of analgesic therapy in ambulatory AIDS patients with and without a history of substance abuse. Pain. 1997;72:235–43.

    Article  CAS  PubMed  Google Scholar 

  4. Perry BA, Westfall AO, Molony E, et al. Characteristics of an ambulatory palliative care clinic for HIV-infected patients. J Palliat Med. 2013;16:934–7.

    Article  PubMed  PubMed Central  Google Scholar 

  5. Johnson A, Condon K, Mapas-Dimaya A, et al. Report of an HIV clinic-based pain management program and utilization of health status and health service by HIV patients. J Opioid Manage. 2011;8:17–27.

    Article  Google Scholar 

  6. Tsao JC, Soto T. Pain in persons living with HIV and comorbid psychological and substance use disorders. Clinic J Pain. 2009;25:307.

    Article  Google Scholar 

  7. Hilary LS, Steven PK, Maria AL-M, Theodore JC, Catherine LO. Pain treatment and antiretroviral medication adherence among vulnerable HIV-positive patients. AIDS Patient Care STDs 2015.

  8. Merlin JS, Westfall AO, Chamot E, et al. Pain is independently associated with impaired physical function in HIV-infected patients. Pain Med. 2013;14:1985–93.

    Article  PubMed  Google Scholar 

  9. Dobalian A, Tsao JC, Duncan RP. Pain and the use of outpatient services among persons with HIV: results from a nationally representative survey. Mel Care. 2004;42:129–38.

    Article  Google Scholar 

  10. Gray G, Berger P. Pain in women with HIV/AIDS. Pain. 2007;132:S13–21.

    Article  PubMed  Google Scholar 

  11. Tsao JC, Plankey MW, Young MA. Pain, psychological symptoms and prescription drug misuse in HIV: a literature review. J Pain Manage. 2012;5:111.

    Google Scholar 

  12. Tsao JC, Stein JA, Dobalian A. Sex differences in pain and misuse of prescription analgesics among persons with HIV. Pain Med. 2010;11:815–24.

    Article  PubMed  PubMed Central  Google Scholar 

  13. MacCarthy S, Hoffmann M, Ferguson L, et al. The HIV care cascade: models, measures and moving forward. J Int AIDS Soc 2015;18

  14. The National HIV/AIDS Strategy for the United States. 2015, at https://aids.gov/federal-resources/national-hiv-aids-strategy/nhas.pdf.Accessed July 2010

  15. Tedaldi EM, Richardson JT, Debes R, et al. Retention in care within 1 year of initial HIV care visit in a multisite US cohort who’s in and who’s out? J Int Associ Provid AIDS Care. 2014;13:232–41.

    Article  Google Scholar 

  16. Eaton EF, Saag MS, Mugavero M. Engagement in human immunodeficiency virus care: linkage, retention, and antiretroviral therapy adherence. Infecti Disease Clinic N Am. 2014;28:355–69.

    Article  Google Scholar 

  17. Skarbinski J, Rosenberg E, Paz-Bailey G, et al. Human immunodeficiency virus transmission at each step of the care continuum in the United States. JAMA Intern Med. 2015;175:588–96.

    Article  PubMed  Google Scholar 

  18. Mugavero MJ, Davila JA, Nevin CR, Giordano TP. From access to engagement: measuring retention in outpatient HIV clinical care. AIDS Patient Care STDs. 2010;24:607–13.

    Article  PubMed  PubMed Central  Google Scholar 

  19. Crawford TN. Poor retention in care one-year after viral suppression: a significant predictor of viral rebound. AIDS Care. 2014;26:1393–9.

    Article  PubMed  Google Scholar 

  20. Mugavero MJ, Westfall AO, Cole SR, et al. Beyond core indicators of retention in HIV care: missed clinic visits are independently associated with all-cause mortality. Clinic Infecti Disease. 2014;59:1471–9.

    Article  CAS  Google Scholar 

  21. Waldrop-Valverde D, Guo Y, Ownby RL, Rodriguez A, Jones DL. Risk and protective factors for retention in HIV care. AIDS Behavior. 2014;18:1483–91.

    Article  PubMed  PubMed Central  Google Scholar 

  22. Merlin JS, Westfall AO, Raper JL, et al. Pain, mood, and substance abuse in HIV: implications for clinic visit utilization, ART adherence, and virologic failure. J Acquire Immune Deficienc Syndrom. 1999;2012(61):164.

    Google Scholar 

  23. Haley DF, Lucas J, Golin CE, et al. Retention strategies and factors associated with missed visits among low income women at increased risk of HIV acquisition in the US (HPTN 064). AIDS Patient Care STDs. 2014;28:206–17.

    Article  PubMed  PubMed Central  Google Scholar 

  24. Tsao JC, Stein JA, Ostrow D, Stall RD, Plankey MW. The mediating role of pain in substance use and depressive symptoms among multicenter AIDS cohort study (MACS) participants. Pain. 2011;152:2757–64.

    Article  PubMed  PubMed Central  Google Scholar 

  25. Blank AE, Espino SLR, Eastwood B, Matoff-Stepp S, Xavier J. The HIV/AIDS women of color initiative improving access to and quality of care for women of color. J Health Care Poor Underserved. 2013;24:15–26.

    Article  PubMed  Google Scholar 

  26. Eastwood EA, Fletcher J, Quinlivan EB, Verdecias N, Birnbaum JM, Blank AE. Baseline social characteristics and barriers to care from a special projects of national significance women of color with HIV study: a comparison of urban and rural women and barriers to HIV care. AIDS Patient Care STDs. 2015;29:S4–10.

    Article  PubMed  PubMed Central  Google Scholar 

  27. Quinlivan EB, Messer LC, Adimora AA, et al. Experiences with HIV testing, entry, and engagement in care by HIV-infected women of color, and the need for autonomy, competency, and relatedness. AIDS Patient Care STDs. 2013;27:408–15.

    Article  PubMed  PubMed Central  Google Scholar 

  28. CDC HRQOL-14 “Healthy Days Measure” 2011, at http://www.cdc.gov/hrqol/hrqol14_measure.htm.Accessed March 15 2011

  29. Moriarty DG, Kobau R, Zack MM, Zahran HS. Tracking healthy days—a window on the health of older adults. Prev Chronic Dis. 2005;2:A16.

    PubMed  PubMed Central  Google Scholar 

  30. Moriarty DG, Zack MM, Kobau R. The centers for disease control and prevention’s healthy days measures-population tracking of perceived physical and mental health over time. Health Qual Life Outcomes. 2003;1:37.

    Article  PubMed  PubMed Central  Google Scholar 

  31. Mielenz T, Jackson E, Currey S, DeVellis R, Callahan LF. Psychometric properties of the centers for disease control and prevention health-related quality of life (CDC HRQOL) items in adults with arthritis. Health Qual Life Outcomes. 2006;4:66.

    Article  PubMed  PubMed Central  Google Scholar 

  32. Altman D. Practical statistics for medical research. Boca Raton: Chapman and Hall; 2010.

    Google Scholar 

  33. Lum PJ, Little S, Botsko M, et al. Opioid-prescribing practices and provider confidence recognizing opioid analgesic abuse in HIV primary care settings. JAIDS J Acquir Immune Deficienc Syndrom. 2011;56:S91–7.

    Article  Google Scholar 

  34. Starrels JL, Wu B, Peyser D, et al. It made my life a little easier: primary care providers’ beliefs and attitudes about using opioid treatment agreements. J Opioid Manage. 2014;10:95.

    Article  Google Scholar 

  35. Reeves WC, Strine TW, Pratt LA, et al. Mental illness surveillance among adults in the United States. MMWR Surveill Summ. 2011;60:1–29.

    Google Scholar 

  36. McClave AK, Dube SR, Strine TW, Mokdad AH. Associations between health-related quality of life and smoking status among a large sample of US adults. Prevent Med. 2009;48:173–9.

    Article  Google Scholar 

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Acknowledgments

We would like to acknowledge HRSA, the SPNS Women of Color Initiative, the participating sites, study participants, and the Montefiore-Einstein Division of General Internal Medicine HIV Research Affinity Group.

Funding

The research described was supported by HRSA WOC Grant Number H97HA15152.(PI: Arthur Blank) and NIH/National Center for Advancing Translational Science (NCATS) Einstein-Montefiore CTSA Grant Number UL1TR001073 and NIH K23MH102129 (PI: Oni Blackstock).

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Authors and Affiliations

  1. Montefiore Medical Center, Bronx, NY, USA

    Stella A. Safo, Chinazo O. Cunningham & Oni J. Blackstock

  2. Albert Einstein College of Medicine, Bronx, NY, USA

    Arthur E. Blank, Chinazo O. Cunningham & Oni J. Blackstock

  3. Institute for Global Health and Infectious Diseases, University of North Carolina, Chapel Hill, NC, USA

    E. Byrd Quinlivan

  4. Center for AIDS Research, University of North Carolina, Chapel Hill, NC, USA

    E. Byrd Quinlivan

  5. Baystate Medical Center & Tufts University School of Medicine, Springfield, MA, USA

    Thomas Lincoln

Authors
  1. Stella A. Safo
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  2. Arthur E. Blank
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  3. Chinazo O. Cunningham
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  4. E. Byrd Quinlivan
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  5. Thomas Lincoln
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  6. Oni J. Blackstock
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Corresponding author

Correspondence to Stella A. Safo.

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Conflict of Interest

The authors declare that they have no competing interests.

Ethical Approval

All procedures performed in this study in accordance with the ethical standards of the Albert Einstein College of Medicine IRB, which are in keeping with the 1964 Helsinki declaration and its later amendments.

Informed Consent

This study was supported by the Albert Einstein College of Medicine IRB and informed consent was obtained from all individual participants included in the study.

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Safo, S.A., Blank, A.E., Cunningham, C.O. et al. Pain is Associated with Missed Clinic Visits Among HIV-Positive Women. AIDS Behav 21, 1782–1790 (2017). https://doi.org/10.1007/s10461-016-1475-x

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  • DOI: https://doi.org/10.1007/s10461-016-1475-x

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