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. 2022 Jan 7;19(1):1.
doi: 10.1186/s12981-021-00425-0.

Routine HIV clinic visit adherence in the African Cohort Study

Nicole Dear  1   2 , Allahna Esber  3   4 , Michael Iroezindu  3   5 , Emmanuel Bahemana  3   6 , Hannah Kibuuka  7 , Jonah Maswai  3   8 , John Owuoth  3   9 , Christina S Polyak  3   4 , Julie A Ake #  3 , Trevor A Crowell #  3   4 ; AFRICOS Study Group
Collaborators, Affiliations

Routine HIV clinic visit adherence in the African Cohort Study

Nicole Dear et al. AIDS Res Ther. .

Abstract

Background: 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.

Keywords: Care retention; Clinic visits; East Africa; HIV; Patient engagement; West Africa.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Frequency of expected clinic visits by year; p < 0.001. The p-value was calculated using a Pearson’s chi-squared test. Between January 2013 and March 2020, people living with HIV were enrolled at 12 HIV clinics in Kenya, Uganda, Tanzania, and Nigeria. The frequency of expected clinic visits is from their first study visit on antiretroviral therapy, which may have been at enrollment into the cohort or later if they were ART-naïve at enrollment. The frequency of expected clinic visits describes how often clients reported they were expected to attend routine clinic visits in the 6-month period prior to the study visit and is based on self-report
Fig. 2
Fig. 2
Proportion of participants missing one or more clinic visits by frequency of routine clinic visits; p = 0.02. The p-value was calculated using a Pearson’s chi-squared test. Between January 2013 and March 2020, people living with HIV were enrolled at 12 HIV clinics in Kenya, Uganda, Tanzania, and Nigeria. The frequency of expected clinic visits is from their first study visit on antiretroviral therapy, which may have been at enrollment into the cohort or later if they were ART-naïve at enrollment. Missed HIV clinic visits were based on self-report and measured as the number of clinic visits missed in the past 6 months. The frequency of expected clinic visits describes how often clients reported they were expected to attend routine clinic visits in the 6-month period prior to the study visit and is based on self-report
Fig. 3
Fig. 3
Reasons for not attending HIV clinic visits in the past 6 months. There were 352 unique participants who missed HIV clinic visits in the 6 months prior to any study visit. Participants could provide more than one response and/or specify a free text response. Free text responses were retrospectively recoded into an existing option or coded as a new category. Free text (unsolicited) responses are indicated as such
See this image and copyright information in PMC

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