Factors associated with the failure of HIV-positive persons to return for scheduled medical visits

Abstract

PURPOSE: To assess in an HIV-positive cohort the cumulative probability of failing to return for scheduled medical visits and to address the factors associated with follow-up discontinuation. METHOD: This was a hospital-based cohort study conducted from January 1985 through September 1999. Out of 3,300 HIV-1 infected patients, 1,680 patients with CD4 count <500 cells/mL or with AIDS diagnosis were included in the analysis because they received scheduled medical visits for follow-up at our center. Baseline visit was the first visit when patients met the criteria for enrollment. The main outcome measure was failure to return for scheduled medical visits for at least 12 consecutive months. RESULTS: The probability of returning decreased rapidly in the first months after the baseline visit. After 1 year since enrollment, 25% of patients failed to return and after 2 years 34% of patients failed to return. Most patients who failed to return for visits (78%) discontinued their follow-up within 6 months since enrollment. In multivariate analysis, patients in the intravenous drug use (IDU) category were most likely to fail to return for scheduled appointments, as were patients with higher CD4 count (CD4 >50 cells/μL) or patients without AIDS diagnosis. Patients with shorter follow-up had a higher risk of failing to return (odds ratio [OR]: 0.12, 0.36, 0.45, and 0.74 for >36, 24-36, 12-24, and 6-12 months of follow-up respectively vs. <6 months). Patients who were enrolled in more recent years had a higher compliance to follow-up visits (OR: 0.33, 0.63, and 0.61 for ≥1997, 1995-1996, and 1988-1994 vs. <1988). CONCLUSION: Patients in the IDU category, patients without AIDS diagnosis, or patients with higher CD4 counts are more likely to miss medical appointments and discontinue their follow-up. More recently enrolled patients have a lower risk of failing to return. It is possible that the recent and more effective anti-HIV treatment played a major role in increasing adherence to follow-up.