U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, MD, USA.
Henry M. Jackson Foundation for the Advancement of Military Medicine, 6720A Rockledge Dr, Suite 400, Bethesda, MD, 20817, USA.
AIDS Res Ther. 2022 Jan 7;19(1):1. doi: 10.1186/s12981-021-00425-0.
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).
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.
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).
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.
在感染艾滋病毒的人群（PLWH）中，坚持临床护理非常重要。有证据表明，错过门诊就诊与中断抗逆转录病毒治疗（ART）、CD4 计数降低、病毒学失败和忽视合并感染有关。我们确定了在非洲队列研究（AFRICOS）中与错过常规门诊就诊相关的因素。
2013 年，AFRICOS 开始在乌干达、肯尼亚、坦桑尼亚和尼日利亚招募感染和未感染 HIV 的人群。在入组时和之后的每 6 个月，都会进行社会人口学问卷调查，并评估临床结局。将错过门诊就诊定义为过去 6 个月内自我报告的错过的门诊就诊次数，并将其分为无、1 次或更多次就诊。使用广义估计方程的 logistic 回归来估计风险因素与错过就诊之间的比值比（OR）和 95%置信区间（CI）。
2013 年 1 月至 2020 年 3 月期间，共招募了 2937 名 PLWH，其中 2807 名（95.6%）已开始接受 ART，2771 名有完整数据可供分析。与 50 岁以上的 PLWH 相比，18-29 岁（OR 2.33，95%CI 1.65-3.29）、30-39 岁（OR 1.59，95%CI 1.19-2.13）和 40-49 岁（OR 1.42，95%CI 1.07-1.89）的 PLWH 更常错过门诊就诊。与接受 ART<2 年的 PLWH 相比，接受 ART4 年或以上的 PLWH 不太可能错过门诊就诊（OR 0.72，95%CI 0.55-0.95）。错过门诊就诊与饮酒（OR 1.34，95%CI 1.05-1.70）、监禁史（OR 1.42，95%CI 1.07-1.88）、抑郁（OR 1.47，95%CI 1.13-1.91）和病毒未抑制（OR 2.50，95%CI 2.00-3.12）有关。与过去一个月没有错过任何 ART 的 PLWH 相比，错过 1-2 天（OR 2.09，95%CI 1.65-2.64）和错过 3 天或以上 ART（OR 7.06，95%CI 5.43-9.19）的 PLWH 更常错过门诊就诊。
不定期就诊与 HIV 相关结局恶化有关。对于年轻的 PLWH 和患有抑郁症的患者，特别需要采取措施提高就诊依从性。
