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Treatment at multiple clinics linked to poorer outcomes in HIV
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Patients with HIV who received care at multiple clinics were nearly 40% less likely to be receiving antiretroviral therapy, according to recent study findings.
The therapeutic patient–provider relationship may be compromised by the receipt of care at multiple clinics, according to the researchers. In the current analysis, they evaluated 12,759 patients with HIV to determine possible adverse effects of therapy at multiple settings.
Eligible participants were adults treated in Philadelphia between 2008 and 2010.
Patients were stratified according to whether they were treated at one or more visits at two or more clinics during a calendar year. ART use and HIV viral load ≤200 copies/mL for patients on ART served as the primary outcome measures.
Results indicated that 8% (n=986) of the study population had received care at multiple clinics. The following groups were more likely to receive care at multiple clinics:
- Younger patients;
- Women;
- Blacks;
- Individuals with public insurance; and
- Individuals in their first year of care.
Results of an adjusted analysis factoring in sociodemographic information indicated that ART use was less likely among patients receiving care at multiple clinics than it was among those treated at one clinic (adjusted OR=0.62; 95% CI, 0.55-0.71). Other results of this analysis indicated that HIV viral suppression was also less common among patients treated at multiple clinics than among those treated at a single clinic (aOR=0.78; 95% CI, 0.66-0.94).
“Qualitative data are needed to understand the reasons for visiting multiple clinics,” the researchers concluded.
Study investigator Kathleen A. Brady, MD, an infectious disease physician at Pennsylvania Hospital and medical director/medical epidemiologist for the Philadelphia Department of Public Health’s AIDS Activities Coordinating Office, discussed the findings in a recent press release. “It’s about retention in care, but also continuity, two related, but distinct processes,” she said. “This paper helps to describe a group of patients in whom there is duplication of services but who also have worse outcomes. I'm hopeful that by providing this data to HIV clinicians, we can get a better understanding of why patients see multiple providers and make improvements to the system to achieve these goals.”
Kathleen A. Brady
Primary investigator Baligh R. Yehia, MD, MPP, MSHP, an assistant professor in the division of infectious diseases at the Perelman School of Medicine at the University of Pennsylvania, built on this point. “Next, researchers should focus on better understanding the reasons behind multiple clinics visit, which could run the gamut,” he said. “Difficulty accepting the diagnosis and coping with stigma may play a role. Many people may move onto another clinic because of comorbidity, like hepatitis C and mental health treatments, which may not be offered at all clinics. Patient-provider interactions may also play a role. All of this information will help us better understand patient behaviors, which can help us improve HIV care.”
Disclosure: Yehia and Brady report no relevant financial disclosures.
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