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Predicting Retention in HIV Primary Care: Is There a Missed Visits Continuum Based on Patient Characteristics?

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Abstract

Missing 3 + scheduled HIV primary care visits over a 1-year period increases mortality risk for people living with HIV (PLWH). We used electronic health data from PLWH (≥ 18 years old) at a southeastern US HIV clinic in 2016 to examine differences across patient-level characteristics and number of missed visits (1–2 vs. 0, 3 + vs. 0, 3 + vs. 1–2). In multivariable multinomial logistic regression analyses, poverty, lack of Ryan White HIV/AIDS Program support services, being uninsured, not having a high school degree, and being younger were significantly associated with 1–2 or 3 + missed visits (vs. 0 missed). Only poverty remained predictive of missing 3 + versus 1–2 visits (RR = 2.70, 95% CI 1.49–4.88). Patients at risk for missing 3 + visits present similar characteristics to patients who miss 1–2 visits. Interventions aimed at poverty reduction and increased access to education, health insurance, and support services may improve retention and, therefore, decrease mortality risk.

Resumen

No acudir a más de tres visitas programadas de VIH en atención primaria durante un período de un año, aumenta el riesgo de mortalidad para las personas que viven con VIH (PLWH). Utilizamos datos electrónicos de salud de 2016 de PLWH (≥ 18 años de edad) en una clínica de VIH del sureste de EE. UU, para examinar las diferencias entre características del paciente y número de visitas perdidas (1–2 vs. 0, 3 + vs. 0, 3 + vs. 1–2). En los análisis multivariables de regresión logística multinomial, la pobreza, la falta del programa de servicios de apoyo Ryan White HIV/AIDS, la carencia de seguro médico, carencia de estudios secundarios, y ser joven, resulta tener una asociación significativa con una dos o más de tres visitas perdidas (vs. 0 perdidas). Solo la pobreza es predictiva de perder más de 3 en comparación con 1–2 visitas (RR = 2,70; IC del 95% = 1,49–4,88). Los pacientes en riesgo de perder más de three visitas presentan características similares a los pacientes que no acuden a 1–2 visitas. Intervenciones dirigidas a la reducción de la pobreza, mayor acceso a la educación y a un seguro médico, así como acceso a servicios de apoyo, pueden mejorar la retención y, por tanto, disminuir el riesgo de mortalidad.

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Authors and Affiliations

  1. University of Michigan, Ann Arbor, MI, USA

    Emma Sophia Kay, Ashley Lacombe-Duncan & Rogério M. Pinto

  2. School of Social Work, University of Michigan, 1080 S University Ave, Ann Arbor, MI, 48109, USA

    Emma Sophia Kay

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  1. Emma Sophia Kay
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Kay, E.S., Lacombe-Duncan, A. & Pinto, R.M. Predicting Retention in HIV Primary Care: Is There a Missed Visits Continuum Based on Patient Characteristics?. AIDS Behav 23, 2542–2548 (2019). https://doi.org/10.1007/s10461-019-02508-6

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