HIV care retention better with 6- month intervals in Zambia

Six-month intervals between clinic visits were associated with improvements in several HIV care retention factors in Zambia, according to researchers.

For example, patients with HIV visiting every 6 months were less likely to miss scheduled visits, fail to pick up medication and become lost to follow-up than those who visited every 3 months, the researchers wrote in Clinical Infectious Diseases.

“We believe these findings have important implications as countries rapidly incorporate visit spacing into their guidelines,” researcher Aaloke Mody, MD, a clinical fellow at the University of California, San Francisco, and colleagues wrote. “Patients face significant burdens and opportunity costs in attending clinic visits due to transportation costs, distance to clinic, time away from work and competing life or family priorities.”

The researchers assessed data from patients who were stable on ART and made visits to any of 20 clinics in Lusaka Province between Jan. 1, 2013, and July 31, 2015. They did not include visits due only to tuberculosis or those in which patients were reported to be acutely ill.

The analysis included 62,084 patients who made 501,281 total clinical visits. Only about 10% of clinical visits came at 6-month intervals, whereas the majority came at 1-, 2- or 3-month intervals.

However, the researchers found that patients visiting every 6 months were 38% less likely than those visiting every 3 months to become lost to follow-up before their next visit (adjusted OR = 0.41; 95% CI, 0.31-0.54 vs. aOR = 0.79; 95% CI, 0.76-0.82).

They were also less likely to miss their next visit by more than 14 days (aOR = 0.20; 95% CI, 0.17-0.24 vs. aOR = 0.50; 95% CI, 0.49-0.52) and to have a gap in medication for more than 14 days (aOR = 0.47; 95% CI, 0.39-0.57 vs. aOR = 0.69; 95% CI, 0.67-0.70).

The researchers concluded that the wider spacing of visits and other adjustments could improve HIV care and make it more efficient as authorities pursue WHO goals of expanding treatment.

“As we move into a new phase of ART treatment with ‘treat all,’ adopting differentiated models of care that can simultaneously better address patient needs, foster sustained engagement and accommodate the expected increase in patient populations will be crucial,” they wrote. “Extending clinic follow-up and pharmacy refills up to 6 months, and potentially even longer, is a relatively straightforward solution requiring minimal additional infrastructure.” – by Joe Green

Disclosure: The researchers report no relevant financial disclosures.