Predicting Retention in HIV Primary Care: Is There a Missed Visits Continuum Based on Patient Characteristics?

Abstract

Missing 3 + scheduled HIV primary care visits over a 1-year period increases mortality risk for people living with HIV (PLWH). We used electronic health data from PLWH (≥ 18years old) at a southeastern US HIV clinic in 2016 to examine differences across patient-level characteristics and number of missed visits (1-2 vs. 0, 3 + vs. 0, 3 + vs. 1-2). In multivariable multinomial logistic regression analyses, poverty, lack of Ryan White HIV/AIDS Program support services, being uninsured, not having a high school degree, and being younger were significantly associated with 1-2 or 3 + missed visits (vs. 0 missed). Only poverty remained predictive of missing 3 + versus 1-2 visits (RR = 2.70, 95% CI 1.49-4.88). Patients at risk for missing 3 + visits present similar characteristics to patients who miss 1-2 visits. Interventions aimed at poverty reduction and increased access to education, health insurance, and support services may improve retention and, therefore, decrease mortality risk.