Routine HIV clinic visit adherence in the African Cohort Study

Abstract

Background 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). Methods 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. Results 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). Conclusions 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.

Predictors and Facilitators of High Viral Load in HIV Positive Persons on Antiretroviral Treatment in the East Region of Cameroon

“…Though the distance to the clinic, according to the study, was not significant to viral suppression (P>0.43), it was greatly significant with adherence to medication (P<0.001). This was consistent with studies carried out in Uganda [23], in Kenya, Nigeria and Tanzania [24]. The social conditions surrounding a patient on ART and the availability of food were found to be determinant of adherence and, thus viral suppression.…”

A qualitative exploration of the psychosocial factors affecting antiretroviral therapy adherence among HIV infected young adults in Eastern Uganda

“…The high volume of patients relative to the few healthcare workers compromises on the quality of client-healthcare worker interaction, privacy, poor quality of care, and failure of the healthcare workers to identify issues of ART adherence among clients [28]. Measures should be developed to reduce long waiting times in ART clinics so as to reduce issues of non-adherence to medications and consequent treatment failure Consistent with findings from previous studies [28,29], poverty, and low-socio economic status contributed to the ART non adherence among HIV young adults. In a scoping review of the factors contributing to ART adherence, logistical and financial support to HIV positive clients were found to facilitate adherence to ART medication [30], which also supports our findings.…”

Effect of Behaviourally Informed Text Messages to Promote Retention in HIV Care: A Randomized Trial in Ekurhuleni District, South Africa

“…Our subgroup analyses showed that among care recipients who had been on treatment for <90 days, loss aversion messages were effective in promoting timely clinic attendance. This is notable since research shows that care recipients who miss visits within the first six months on treatment have increased likelihood of poor outcomes (22,24). Care recipients who have been on treatment for >90 days may have become accustomed to clinic messages or may feel it is less important to come to the clinic on or before the scheduled appointment date especially if they still have medication in hand.…”

“…Second, it could be that reasons for not having timely clinic attendance have been due to structural and economic barriers such as high transportation costs, opportunity costs of time, or long clinic wait times. These barriers have been shown to significantly impact clinic attendance, particularly for marginalized and underserved populations (22,23), and they are less likely to be addressed by text messages. Third, the lack of timely clinic attendance may be due to the perception of a scheduled clinic visit date as merely being a suggested date to come to the clinic rather than an exact appointment date.…”