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

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
• adherence
• missed visit
• HIV

Disclosure statement

No potential conflict of interest was reported by the authors.

Additional information

Funding

The TREAT Asia HIV Observational Database is an initiative of TREAT Asia, a program of amfAR, The Foundation for AIDS Research, with support from the U.S. National Institutes of Health’s National Institute of Allergy and Infectious Diseases, the Eunice Kennedy Shriver National Institute of Child Health and Human Development, the National Cancer Institute, the National Institute of Mental Health, and the National Institute on Drug Abuse, as part of the International Epidemiology Databases to Evaluate AIDS (IeDEA; U01AI069907). The Kirby Institute is funded by the Australian Government Department of Health and Ageing, and is affiliated with the Faculty of Medicine, UNSW Sydney. The content of this publication is solely the responsibility of the authors and does not necessarily represent the official views of any of the governments or institutions mentioned above.