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Outcomes of HIV-Infected Patients Receiving Care at Multiple Clinics

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Abstract

Receiving care at multiple clinics may compromise the therapeutic patient-provider alliance and adversely affect the treatment of people living with HIV. We evaluated 12,759 HIV-infected adults in Philadelphia, PA between 2008 and 2010 to determine the effects of using multiple clinics for primary HIV care. Using generalized estimating equations with logistic regression, we examined the relationship between receiving care at multiple clinics (≥1 visit to two or more clinics during a calendar year) and two outcomes: (1) use of ART and (2) HIV viral load ≤200 copies/mL for patients on ART. Overall, 986 patients (8 %) received care at multiple clinics. The likelihood of attending multiple clinics was greater for younger patients, women, blacks, persons with public insurance, and for individuals in their first year of care. Adjusting for sociodemographic factors, patients receiving care at multiple clinics were less likely to use ART (AOR = 0.62, 95 % CI 0.55–0.71) and achieve HIV viral suppression (AOR = 0.78, 95 % CI 0.66–0.94) than individuals using one clinic. Qualitative data are needed to understand the reasons for visiting multiple clinics.

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Acknowledgments

We are grateful to all the patients, physicians, investigators, and staff involved in the Philadelphia Ryan White System. We would like to acknowledge the staff of the Philadelphia Department of Health AIDS Activities Coordinating Office including Jane Baker, Coleman Terrell, Marlene Matosky, and Ethan Schofer. The study was supported by the Penn Center for AIDS Research (P30 AI 045008). BRY and JPM were supported by the National Institutes of Health (K23-MH097647-01A and K24-AI073957-05, respectively). SCK was supported by the Agency for Healthcare Research and Quality (400-4239-4-555854-2446-2192).

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Authors and Affiliations

  1. Department of Medicine, Perelman School of Medicine, University of Pennsylvania, 1021 Blockley Hall, 423 Guardian Drive, Philadelphia, PA, 19104, USA

    Baligh R. Yehia, Sara C. Keller, Robert Gross, Ian Frank & Kathleen A. Brady

  2. Philadelphia Veterans Affairs Center for Health Equity Research and Promotion, Philadelphia, PA, USA

    Baligh R. Yehia & Robert Gross

  3. Department of Medicine, New York University, New York, NY, USA

    Asher J. Schranz

  4. Department of Medicine, Temple University School of Medicine, Philadelphia, PA, USA

    Florence Momplaisir

  5. Department of Biostatistics and Epidemiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA

    Robert Gross

  6. General Medicine Division, Massachusetts General Hospital, Boston, MA, USA

    Joshua P. Metlay

  7. Philadelphia Department of Public Health, AIDS Activities Coordinating Office, Philadelphia, PA, USA

    Kathleen A. Brady

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  1. Baligh R. Yehia
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  2. Asher J. Schranz
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  3. Florence Momplaisir
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Correspondence to Baligh R. Yehia.

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Yehia, B.R., Schranz, A.J., Momplaisir, F. et al. Outcomes of HIV-Infected Patients Receiving Care at Multiple Clinics. AIDS Behav 18, 1511–1522 (2014). https://doi.org/10.1007/s10461-013-0625-7

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