AIDS and Behavior

, Volume 23, Issue 2, pp 418–426 | Cite as

Who Will Show? Predicting Missed Visits Among Patients in Routine HIV Primary Care in the United States

  • Brian W. PenceEmail author
  • Angela M. Bengtson
  • Stephen Boswell
  • Katerina A. Christopoulos
  • Heidi M. Crane
  • Elvin Geng
  • Jeanne C. Keruly
  • W. Christopher Mathews
  • Michael J. Mugavero
Original Paper


Missed HIV medical visits predict poor clinical outcomes. We sought to identify patients at high risk of missing visits. We analyzed 2002–2014 data from six large US HIV clinics. At each visit, we predicted the likelihood of missing the next scheduled visit using demographic, clinical, and patient-reported psychosocial variables. Overall, 10,374 participants contributed 105,628 HIV visits. For 17% of visits, the next scheduled appointment was missed. The strongest predictor of a future missed visit was past-year missed visits. A model with only this predictor had area under the receiver operator curve = 0.65; defining “high risk” as those with any past-year missed visits had 73% sensitivity and 51% specificity in correctly identifying a future missed visit. Inclusion of other clinical and psychosocial predictors only slightly improved performance. Past visit attendance can identify those at increased risk for future missed visits, allowing for proactive allocation of resources to those at greatest risk.


HIV Retention in care Missed visits Appointment attendance Predictive models 



BWP, SB, KC, HMC, EG, WCM, and MJM contributed to the acquisition of the data; BWP designed the analysis; BWP and MJM drafted the manuscript; BWP, AMB, SB, KC, SRC, HMC, EG, JK, WCM, and MJM assisted with the interpretation of the data and critically revised the manuscript for important intellectual content. All authors take responsibility for and approve the final version of the manuscript. We thank the National Institutes of Mental Health [Grant Number R01MH100970] and the National Institute of Allergy and Infectious Diseases [Grant Numbers R24AI067039 and P30 AI50410] for their support of this work.


This work was supported by the National Institutes of Mental Health [Grant Number R01MH100970 to BWP] and by the National Institute of Allergy and Infectious Disease [Grant Numbers R24AI067039, P30AI50410].

Compliance with Ethical Standards

Conflict of interest

BWP has received a speaking honorarium from MSD. KAC has been a scientific advisory board member for Roche and a community advisory board member for Gilead.

Supplementary material

10461_2018_2215_MOESM1_ESM.docx (80 kb)
Supplementary material 1 (DOCX 79 kb)


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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  • Brian W. Pence
    • 1
    Email author
  • Angela M. Bengtson
    • 2
  • Stephen Boswell
    • 3
  • Katerina A. Christopoulos
    • 4
  • Heidi M. Crane
    • 5
  • Elvin Geng
    • 4
  • Jeanne C. Keruly
    • 6
  • W. Christopher Mathews
    • 7
  • Michael J. Mugavero
    • 8
  1. 1.Department of Epidemiology, Gillings School of Global Public HealthThe University of North Carolina at Chapel HillChapel HillUSA
  2. 2.Department of EpidemiologyBrown UniversityProvidenceUSA
  3. 3.Fenway HealthBostonUSA
  4. 4.Division of HIV, ID and Global Medicine, Zuckerberg San Francisco General HospitalUniversity of California San FranciscoSan FranciscoUSA
  5. 5.Department of Medicine, School of MedicineUniversity of WashingtonSeattleUSA
  6. 6.Department of Medicine, School of MedicineJohns Hopkins UniversityBaltimoreUSA
  7. 7.Department of Medicine, School of MedicineUniversity of California, San DiegoSan DiegoUSA
  8. 8.Department of Medicine and UAB Center for AIDS ResearchUniversity of Alabama at BirminghamBirminghamUSA

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