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AIDS Care. 2018 Dec;30(12):1560-1566. doi: 10.1080/09540121.2018.1499859. Epub 2018 Jul 18.

Early suboptimal ART adherence was associated with missed clinical visits in HIV-infected patients in Asia.

Author information

1
a The Kirby Institute , UNSW Sydney , NSW , Australia.
2
b HIV-NAT, The Thai Red Cross AIDS Research Centre , Bangkok , Thailand.
3
c Faculty of Medicine Ramathibodi Hospital , Mahidol University , Bangkok , Thailand.
4
d University of Malaya Medical Centre , Kuala Lumpur , Malaysia.
5
e Beijing Ditan Hospital, Capital Medical University , Beijing , People's Republic of China.
6
f Research Institute for Health Sciences , Chiang Mai University , Chiang Mai , Thailand.
7
g Taipei Veterans General Hospital , Taipei , Taiwan.
8
h National Center for HIV/AIDS, Dermatology and STDs , Phnom Penh , Cambodia.
9
i University of Health Sciences , Phnom Penh , Cambodia.
10
j YRGCARE Medical Centre , Chennai , India.
11
k Research Institute for Tropical Medicine , Manila , Philippines.
12
l Institute of Infectious Diseases , Pune , India.
13
m Working Group on AIDS, Faculty of Medicine , University of Indonesia/Cipto Mangunkusumo Hospital , Jakarta , Indonesia.
14
n Bach Mai Hospital , Hanoi , Vietnam.
15
o Faculty of Medicine , Udayana University & Sanglah Hospital , Bali , Indonesia.
16
p National Hospital for Tropical Diseases , Hanoi , Vietnam.
17
q Queen Elizabeth Hospital , Hong Kong , People's Republic of China.
18
r Division of Infectious Diseases, Department of Internal Medicine , Yonsei University College of Medicine , Seoul , South Korea.
19
s National Center for Global Health and Medicine , Tokyo , Japan.
20
t Chiangrai Prachanukroh Hospital , Chiang Rai , Thailand.
21
u Hospital Sungai Buloh , Sungai Buloh , Malaysia.
22
v Department of Infectious Diseases , Tan Tock Seng Hospital , Singapore , Singapore.
23
w TREAT Asia, amfAR - The Foundation for AIDS Research , Bangkok , Thailand.

Abstract

Missed clinic visits can lead to poorer treatment outcomes in HIV-infected patients. Suboptimal antiretroviral therapy (ART) adherence has been linked to subsequent missed visits. Knowing the determinants of missed visits in Asian patients will allow for appropriate counselling and intervention strategies to ensure continuous engagement in care. A missed visit was defined as having no assessments within six months. Repeated measures logistic regression was used to analyse factors associated with missed visits. A total of 7100 patients were included from 12 countries in Asia with 2676 (37.7%) having at least one missed visit. Patients with early suboptimal self-reported adherence <95% were more likely to have a missed visit compared to those with adherence ≥95% (OR = 2.55, 95% CI(1.81-3.61)). Other factors associated with having a missed visit were homosexual (OR = 1.45, 95%CI(1.27-1.66)) and other modes of HIV exposure (OR = 1.48, 95%CI(1.27-1.74)) compared to heterosexual exposure; using PI-based (OR = 1.33, 95%CI(1.15-1.53) and other ART combinations (OR = 1.79, 95%CI(1.39-2.32)) compared to NRTI+NNRTI combinations; and being hepatitis C co-infected (OR = 1.27, 95%CI(1.06-1.52)). Patients aged >30 years (31-40 years OR = 0.81, 95%CI(0.73-0.89); 41-50 years OR = 0.73, 95%CI(0.64-0.83); and >50 years OR = 0.77, 95%CI(0.64-0.93)); female sex (OR = 0.81, 95%CI(0.72-0.90)); and being from upper middle (OR = 0.78, 95%CI(0.70-0.80)) or high-income countries (OR = 0.42, 95%CI(0.35-0.51)), were less likely to have missed visits. Almost 40% of our patients had a missed clinic visit. Early ART adherence was an indicator of subsequent clinic visits. Intensive counselling and adherence support should be provided at ART initiation in order to optimise long-term clinic attendance and maximise treatment outcomes.

KEYWORDS:

Asia; HIV; adherence; missed visit

PMID:
30021450
PMCID:
PMC6181773
[Available on 2019-12-01]
DOI:
10.1080/09540121.2018.1499859

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