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Multicenter Study
. 2015 Oct;105(10):2068-75.
doi: 10.2105/AJPH.2015.302695. Epub 2015 Aug 13.

The Contribution of Missed Clinic Visits to Disparities in HIV Viral Load Outcomes

Anne Zinski  1 , Andrew O Westfall  1 , Lytt I Gardner  1 , Thomas P Giordano  1 , Tracey E Wilson  1 , Mari-Lynn Drainoni  1 , Jeanne C Keruly  1 , Allan E Rodriguez  1 , Faye Malitz  1 , D Scott Batey  1 , Michael J Mugavero  1
Affiliations
Multicenter Study

The Contribution of Missed Clinic Visits to Disparities in HIV Viral Load Outcomes

Anne Zinski et al. Am J Public Health. 2015 Oct.

Abstract

Objectives: We explored the contribution of missed primary HIV care visits ("no-show") to observed disparities in virological failure (VF) among Black persons and persons with injection drug use (IDU) history.

Methods: We used patient-level data from 6 academic clinics, before the Centers for Disease Control and Prevention and Health Resources and Services Administration Retention in Care intervention. We employed staged multivariable logistic regression and multivariable models stratified by no-show visit frequency to evaluate the association of sociodemographic factors with VF. We used multiple imputations to assign missing viral load values.

Results: Among 10 053 patients (mean age = 46 years; 35% female; 64% Black; 15% with IDU history), 31% experienced VF. Although Black patients and patients with IDU history were significantly more likely to experience VF in initial analyses, race and IDU parameter estimates were attenuated after sequential addition of no-show frequency. In stratified models, race and IDU were not statistically significantly associated with VF at any no-show level.

Conclusions: Because missed clinic visits contributed to observed differences in viral load outcomes among Black and IDU patients, achieving an improved understanding of differential visit attendance is imperative to reducing disparities in HIV.

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Figures

FIGURE 1—
FIGURE 1—
Percentage of (a) virological failure by race stratified by frequency of no-show visits and (b) no-show visits by race: Centers for Disease Control and Prevention and Health Resources and Services Administration Retention in Care preintervention, 6 US metropolitan areas, May 2008 to April 2009. Note. The metropolitan areas surveyed were in Baltimore, MD; Birmingham, AL; Boston, MA; Brooklyn, NY; Houston, TX; and Miami, FL.
FIGURE 2—
FIGURE 2—
Percentage of (a) virological failure by risk factor stratified by frequency of no-show visits and (b) no-show visits by risk factor: Centers for Disease Control and Prevention and Health Resources and Services Administration Retention in Care preintervention, 6 US metropolitan areas, May 2008 to April 2009. Note. IDU = intravenous drug use; MSM = men who have sex with men. The metropolitan areas surveyed were in Baltimore, MD; Birmingham, AL; Boston, MA; Brooklyn, NY; Houston, TX; and Miami, FL.
See this image and copyright information in PMC

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