Retention Strategies and Factors Associated with Missed Visits Among Low Income Women at Increased Risk of HIV Acquisition in the US (HPTN 064)

Abstract

Women at high-risk for HIV acquisition often face challenges that hinder their retention in HIV prevention trials. These same challenges may contribute to missed clinical care visits among HIV-infected women. This article, informed by the Gelberg-Andersen Behavioral Model for Vulnerable Populations, identifies factors associated with missed study visits and describes the multifaceted retention strategies used by study sites. HPTN 064 was a multisite, longitudinal HIV seroincidence study in 10 US communities. Eligible women were aged 18-44 years, resided in a census tract/zipcode with high poverty and HIV prevalence, and self-reported ≥1 personal or sex partner behavior related to HIV acquisition. Multivariate analyses of predisposing (e.g., substance use) and enabling (e.g., unmet health care needs) characteristics, and study attributes (i.e., recruitment venue, time of enrollment) identified factors associated with missed study visits. Retention strategies included: community engagement; interpersonal relationship building; reduction of external barriers; staff capacity building; and external tracing. Visit completion was 93% and 94% at 6 and 12 months. Unstable housing and later date of enrollment were associated with increased likelihood of missed study visits. Black race, recruitment from an outdoor venue, and financial responsibility for children were associated with greater likelihood of attendance. Multifaceted retention strategies may reduce missed study visits. Knowledge of factors associated with missed visits may help to focus efforts.

Association between patient engagement in HIV care and antiretroviral therapy medication adherence: cross-sectional evidence from a regional HIV care center in Kenya

“…For example, studies conducted in East Africa have suggested unemployment, lower income, transportation costs, and other poverty indicators as likely barriers to retention in HIV care (Asefa, Taha, Dejene, & Dube, 2013;Namusobya et al, 2013). Similar results elsewhere indicate that women are more likely to miss appointments (Edwards, Parrish, Frieson, Crawford, & Thornton, 2011;Mugavero et al, 2009), delay seeking care (Tobias et al, 2007), and have unmet HIV-related health-care needs (Haley et al, 2014). Moreover, qualitative findings suggest childcare, socioeconomic commitments, and health services access as major barriers to patient engagement in HIV care (Rao et al, 2013).…”

Regression to the mean and changes in risk behavior following study enrollment in a cohort of U.S. women at risk for HIV

“…At screening, a total of 3234 of these women (78.4%) reported unprotected sex with a male during the past 6 months (screened “positive”) and 2099 of these (64.9%) chose to participate in HPTN 064. Details on followup and retention are provided elsewhere 9,13 .…”

Sex, Race, and HIV Risk Disparities in Discontinuity of HIV Care After Antiretroviral Therapy Initiation in the United States and Canada

“…39,40 Some studies with single-sex populations have noted that poverty and housing instability reduce retention and ART adherence. 41,42 We maintain that the absence of these data has been mitigated by the fact that all patients under study were successfully engaged in care (a prerequisite for the NA-ACCORD) and had access to ART. Immune status of individuals at ART start was also included in adjusted models, accounting for complications due to late care initiation (i.e., low CD4 + count).…”