Original Paper

AIDS and Behavior

, Volume 18, Issue 8, pp 1511-1522

Outcomes of HIV-Infected Patients Receiving Care at Multiple Clinics

  • Baligh R. YehiaAffiliated withDepartment of Medicine, Perelman School of Medicine, University of PennsylvaniaPhiladelphia Veterans Affairs Center for Health Equity Research and Promotion Email author 
  • , Asher J. SchranzAffiliated withDepartment of Medicine, New York University
  • , Florence MomplaisirAffiliated withDepartment of Medicine, Temple University School of Medicine
  • , Sara C. KellerAffiliated withDepartment of Medicine, Perelman School of Medicine, University of Pennsylvania
  • , Robert GrossAffiliated withDepartment of Medicine, Perelman School of Medicine, University of PennsylvaniaPhiladelphia Veterans Affairs Center for Health Equity Research and PromotionDepartment of Biostatistics and Epidemiology, Perelman School of Medicine, University of Pennsylvania
  • , Ian FrankAffiliated withDepartment of Medicine, Perelman School of Medicine, University of Pennsylvania
  • , Joshua P. MetlayAffiliated withGeneral Medicine Division, Massachusetts General Hospital
  • , Kathleen A. BradyAffiliated withDepartment of Medicine, Perelman School of Medicine, University of PennsylvaniaPhiladelphia Department of Public Health, AIDS Activities Coordinating Office

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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.

Keywords

HIV care HIV clinics Use of multiple clinics HIV outcomes Viral suppression