Predicting Retention in HIV Primary Care: Is There a Missed Visits Continuum Based on Patient Characteristics?

Area of Science:

• Public Health
• Infectious Diseases
• Health Services Research

Background:

• Adherence to scheduled primary care visits is crucial for managing HIV and reducing mortality.
• Missing three or more visits annually is linked to increased mortality risk in people living with HIV (PLWH).
• Understanding patient-level characteristics associated with missed visits is essential for improving retention in care.

Purpose of the Study:

• To examine patient-level characteristics associated with missing HIV primary care visits.
• To compare factors linked to missing 1-2 visits versus 0 visits, and 3+ visits versus 0 or 1-2 visits.
• To identify predictors of significant visit attrition (3+ missed visits) for targeted intervention.

Main Methods:

• Utilized electronic health data from PLWH (≥18 years) at a southeastern US HIV clinic in 2016.
• Employed multivariable multinomial logistic regression to analyze associations between patient characteristics and missed visit counts.
• Examined differences across three categories: 0 missed visits, 1-2 missed visits, and 3+ missed visits.

Main Results:

• Poverty, lack of Ryan White HIV/AIDS Program support, being uninsured, lower educational attainment, and younger age were associated with missing 1-2 or 3+ visits compared to zero missed visits.
• Poverty was the only significant predictor of missing 3+ visits versus 1-2 visits (RR=2.70).
• Patient profiles at risk for missing 3+ visits largely overlap with those missing 1-2 visits.

Conclusions:

• Patients at high risk for missing multiple HIV care appointments share characteristics with those missing fewer appointments.
• Interventions addressing poverty, improving access to education, health insurance, and support services are vital.
• Enhancing retention in care through socioeconomic support can potentially decrease mortality risk for PLWH.