Routine HIV clinic visit adherence in the African Cohort Study
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Date
2022
Journal Title
Journal ISSN
Volume Title
Publisher
AIDS research and therapy
Abstract
Retention in clinical care is important for people living with HIV (PLWH). Evidence suggests that missed
clinic visits are associated with interruptions in antiretroviral therapy (ART), lower CD4 counts, virologic failure, and
overlooked coinfections. We identified factors associated with missed routine clinic visits in the African Cohort Study
(AFRICOS).
Methods: In 2013, AFRICOS began enrolling people with and without HIV in Uganda, Kenya, Tanzania, and Nigeria. At
enrollment and every 6 months thereafter, sociodemographic questionnaires are administered and clinical outcomes
assessed. Missed clinic visits were measured as the self-reported number of clinic visits missed in the past 6 months
and dichotomized into none or one or more visits missed. Logistic regression with generalized estimating equations
was used to estimate odds ratios (ORs) and 95% confidence intervals (CIs) for associations between risk factors and
missed visits.
Results: Between January 2013 and March 2020, 2937 PLWH were enrolled, of whom 2807 (95.6%) had initiated ART
and 2771 had complete data available for analyses. Compared to PLWH 50+, missed clinic visits were more common
among those 18–29 years (aOR 2.33, 95% CI 1.65–3.29), 30–39 years (aOR 1.59, 95% CI 1.19–2.13), and 40–49 years
(aOR 1.42, 95% CI 1.07–1.89). As compared to PLWH on ART for < 2 years, those on ART for 4+ years were less likely to
have missed clinic visits (aOR 0.72, 95% CI 0.55–0.95). Missed clinic visits were associated with alcohol use (aOR 1.34,
95% CI 1.05–1.70), a history of incarceration (aOR 1.42, 95% CI 1.07–1.88), depression (aOR 1.47, 95% CI 1.13–1.91),
and viral non-suppression (aOR 2.50, 95% CI 2.00–3.12). As compared to PLWH who did not miss any ART in the past
month, missed clinic visits were more common among those who missed 1–2 days (aOR 2.09, 95% CI 1.65–2.64) and
3+ days of ART (aOR 7.06, 95% CI 5.43–9.19).
Conclusions: Inconsistent clinic attendance is associated with worsened HIV-related outcomes. Strategies to
improve visit adherence are especially needed for young PLWH and those with depression.
Description
Keywords
HIV, East Africa, Clinic visits, Patient engagement, Care retention
Citation
Dear, N., Esber, A., Iroezindu, M., Bahemana, E., Kibuuka, H., Maswai, J., ... & Crowell, T. A. (2022). Routine HIV clinic visit adherence in the African Cohort Study. AIDS research and therapy, 19(1), 1-12. https://doi.org/10.1186/s12981-021-00425-0