Patterns of Geographic Mobility Predict Barriers to Engagement in HIV Care and Antiretroviral Treatment Adherence

Taylor, Barbara S.; Reyes, Emily V.; Levine, Elizabeth A.; Khan, Samiya; Garduño, L. Sergio; Donastorg, Yeycy; Hammer, Scott M.; Brudney, Karen; Hirsch, Jennifer S.

doi:10.1089/apc.2014.0028

Cited by 71 publications

(67 citation statements)

References 49 publications

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“…10,14,16,33 The association between race and appointment attendance could be explained by potential unmeasured mediators such as socioeconomic status, lack of transportation, proximity to health care centers, challenges navigating the healthcare system, geographic mobility, point of HIV-infection identification, pregnancy, and aspects of the patient-provider relationship. 10,[34][35][36][37][38][39][40] Additionally, factors more unique to patients with HIV-infection, including stigma and HIV status disclosure, are known to affect appointment attendance. 41 These factors are not routinely measured as part of clinical care and would be difficult to operationalize.…”

Section: Discussionmentioning

confidence: 99%

Risk Prediction Tool for Medical Appointment Attendance Among HIV-Infected Persons with Unsuppressed Viremia

Woodward

Person²,

Rebeiro³

et al. 2015

AIDS Patient Care and STDs

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Successful treatment of HIV infection requires regular clinical follow-up. A previously published risk-prediction tool (RPT) utilizing data from the electronic health record (EHR) including medication adherence, previous appointment attendance, substance abuse, recent CD4 + count, prior antiretroviral therapy (ART) exposure, prior treatment failure, and recent HIV-1 viral load (VL) has been shown to predict virologic failure at 1 year. If this same tool could be used to predict the more immediate event of appointment attendance, high-risk patients could be identified and interventions could be targeted to improve this outcome. We conducted an observational cohort study at the Vanderbilt Comprehensive Care Clinic from August 2013 through March 2014. Patients with routine medical appointments and most recent HIV-1 VL > 200 copies/mL were included. Risk scores for a modified RPT were calculated based on data from the EHR. Odds ratios (OR) for missing the next appointment were estimated using multivariable logistic regression. Among 510 persons included, median age was 39 years, 74% were male, 55% were black, median CD4 + count was 327 cells/mm 3 [Interquartile Range (IQR): 142-560], and median HIV-1 VL was 21,818 copies/mL (IQR: 2,030-69,597). Medium [OR 3.95, 95% confidence interval (CI) 2.08-7.50, p-value < 0.01] and high (OR 9.55,, p-value < 0.01) vs. low RPT risk scores were independently associated with missing the next appointment. RPT scores, constructed using readily available data, allow for risk-stratification of HIV medical appointment non-attendance and could support targeting limited resources to improve appointment adherence in groups most at-risk of poor HIV outcomes.

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Section: Discussionmentioning

confidence: 99%

Risk Prediction Tool for Medical Appointment Attendance Among HIV-Infected Persons with Unsuppressed Viremia

Woodward

Person²,

Rebeiro³

et al. 2015

AIDS Patient Care and STDs

View full text Add to dashboard Cite

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“…Our findings still may reflect some differences in late diagnosis, as well as differences in rate of disease progression, delayed linkage to and/or retention in care, and access to and/or adherence to antiretroviral treatment. The unique opportunity to travel back and forth between mainland US and Puerto Rico might cause detrimental disruption in HIV care leading to poor health outcomes (Taylor et al 2014). In addition, Puerto Ricans report lower median household income and have the second highest poverty rate among the 10 largest Latino ethnic subgroups (Motel et al 2012).…”

Section: Discussionmentioning

confidence: 99%

Neighborhood Latino ethnic density and mortality among HIV-positive Latinos by birth country/region, Florida, 2005–2008

et al. 2015

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Objective Lower mortality for Latinos has been reported in high Latino density areas. The objective was to examine the contribution of neighborhood Latino density to mortality among HIV-positive Latinos. Methods Florida HIV surveillance data for 2005–2008 were merged with 2007–2011 American Community Survey data using zip code tabulation areas. Hazard ratios (HR) were calculated using multi-level weighted Cox regression and adjusted for individual-level factors and neighborhood poverty. Results Of 4649 HIV-positive Latinos, 11.8% died. There was no difference in mortality risk across categories of Latino ethnic density for Latinos as a whole. There were subgroup effects wherein mortality risk differed by ethnic density category for Latinos born in some countries/regions. Residing in an area with ≥50% Latinos compared with <25% was associated with increased mortality risk for Latinos born in Puerto Rico (HR 1.67; 95% CI [1.01–2.70]). Residing in an area where Mexicans were the majority Latino group was associated with increased mortality risk for Latinos born in Mexico (HR 3.57; 95% CI [1.43–10.00]). Conclusions The survival advantage seen among the Latino population in high Latino density areas was not seen among HIV-positive Latinos. Research is needed to determine if this may be related to stigma or another mechanism.

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“…Population movement has received much attention in the context of the HIV epidemic . Migration and mobility may be associated with HIV acquisition and providing HIV care to mobile populations presents particular challenges . In South Africa, movement between rural and urban areas for employment, education, healthcare, cultural and family reasons occurs frequently, involving all demographic groups, including women of reproductive age .…”

Section: Introductionmentioning

confidence: 99%

Linkage to care, mobility and retention of HIV‐positive postpartum women in antiretroviral therapy services in South Africa

et al. 2018

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IntroductionLinkage to care and mobility postpartum present challenges to long‐term retention after initiating antiretroviral therapy (ART) in pregnancy, but there are few insights from sub‐Saharan Africa. We aimed to describe postpartum linkage to care, mobility, retention and viral suppression after ART initiation in pregnancy.MethodsUsing routine electronic data we assessed HIV‐specific health contacts and clinic movements among women initiating ART in an integrated antenatal care (ANC) and ART clinic in Cape Town, South Africa. The local care model includes mandatory transfer to general ART clinics postpartum. We investigated linkage to care after leaving the integrated clinic and mobility to new clinics until 30 months on ART. We used Poisson regression to explore predictors of linkage, retention (accessing care at least once at both 12 [6 to <18] and 24 [18 to <30] months on ART), and viral suppression (HIV viral load [VL] ≤50 and ≤1000 copies/mL after 12 months on ART).ResultsAmong 617 women, 23% never linked to care; 71% and 65% were retained at 12 and 24 months on ART respectively, with 59% retained in care at both times. Those who linked (n = 485) accessed HIV care at 98 different clinics and 21% attended ≥2 clinics. Women >25 years, married/cohabiting or presenting early for ANC were more likely to link. Younger and unemployed women were more likely to attend ≥2 clinics (adjusted risk ratio [aRR] 1.10 95% confidence interval [CI] 1.02 to 1.18 and aRR 1.06 95% CI 0.99 to 1.12 respectively). Age >25 years (aRR 1.17 95% CI 1.02 to 1.33) and planned pregnancy (aRR 1.20 95% CI 1.09 to 1.33) were associated with being retained. Among 338 retained women with VL available, attending ≥2 clinics reduced the likelihood of viral suppression when defined as ≤50 copies/mL (aRR 0.81 95% CI 0.69 to 0.95). Distance moved was not associated with VL.ConclusionsThese data show that a substantial proportion of women do not link to postpartum ART care in this setting and, among those that do, long‐term retention remains a challenge. Women move to a variety of clinics and young women appear particularly vulnerable to attrition. Interventions promoting linkage and continued retention for women initiating ART during pregnancy warrant urgent consideration.

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Patterns of Geographic Mobility Predict Barriers to Engagement in HIV Care and Antiretroviral Treatment Adherence

Cited by 71 publications

References 49 publications

Risk Prediction Tool for Medical Appointment Attendance Among HIV-Infected Persons with Unsuppressed Viremia

Risk Prediction Tool for Medical Appointment Attendance Among HIV-Infected Persons with Unsuppressed Viremia

Neighborhood Latino ethnic density and mortality among HIV-positive Latinos by birth country/region, Florida, 2005–2008

Linkage to care, mobility and retention of HIV‐positive postpartum women in antiretroviral therapy services in South Africa

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