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Missed clinic visits predictor of mortality in HIV
All-cause mortality risk was increased among patients with HIV who missed more than two clinic visits, according to researchers at the University of Alabama at Birmingham.
“The additional assessment of missed clinic visits in conjunction with [Institute of Medicine] and [Department of Health and Human Services] HIV retention in care core indicators meaningfully enhanced prognostic value for all-cause mortality among patients initiating ART,” the researchers wrote in Clinical Infectious Diseases. “Accordingly, caution is warranted in relying solely upon core indicators to define retention in care and to inform local, state and national programmatic planning.”
The researchers analyzed data from the Centers for AIDS Research (CFAR) Network of Integrated Clinical Systems, which included more than 28,000 patients with HIV who received care at one of eight CFAR sites since 1995. This study included 3,672 ART-naive participants who started treatment from January 2000 to July 2010 and were alive 24 months after ART initiation. They measured retention in care using the Institute of Medicine (IOM) core indicator, the HHS core indicator and the number of missed primary HIV care clinic visits.
At 24 months, 64% of the patients met the IOM core indicator, defined as two visits attended, separated by at least 90 days, in a 12-month period. The HHS core indicator, defined as at least one visit in each 6-month period during a 24-month period, with at least 60 days between visits, was met by 59% of the patients. Missed visits were categorized as zero missed visits, one to two missed visits and more than two missed visits. There was an average of 2.1 missed visits accrued.
During 16,102 person-years of follow-up, 332 patients died. Overall, mortality rates were lower among patients classified as retained in care by the core indicators and with zero missed visits. After adjustment, failure to achieve either of the core indicators and missed clinic visits were all associated with increased mortality. Among patients who were classified as retained in care by the IOM, those with more than two missed visits had an increased mortality risk (HR=3.61; 95% CI, 2.35-5.55), as did those classified as retained in care by the HHS IOM (HR=3.62; 95% CI, 2.3-5.68).
“Missed clinic visits are an important indicator with independent value that can be used along with core indicators to guide allocation of limited resources in an effort to optimize individual and population health outcomes,” the researchers wrote.
Disclosure: The researchers report no relevant financial disclosures.