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


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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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.


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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Correspondence to Stella A. Safo.

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The authors declare that they have no competing interests.

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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.

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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).

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  • Ambulatory care
  • Pain
  • Retention
  • Substance abuse