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Improved Retention With 6-Month Clinic Return Intervals for Stable Human Immunodeficiency Virus-Infected Patients in Zambia.
Mody, Aaloke; Roy, Monika; Sikombe, Kombatende; Savory, Thea; Holmes, Charles; Bolton-Moore, Carolyn; Padian, Nancy; Sikazwe, Izukanji; Geng, Elvin.
Afiliação
  • Mody A; Division of HIV, ID, and Global Medicine, University of California, San Francisco and Zuckerberg San Francisco General Hospital.
  • Roy M; Division of HIV, ID, and Global Medicine, University of California, San Francisco and Zuckerberg San Francisco General Hospital.
  • Sikombe K; Centre for Infectious Diseases Research in Zambia, Lusaka, Zambia.
  • Savory T; Centre for Infectious Diseases Research in Zambia, Lusaka, Zambia.
  • Holmes C; Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, Maryland.
  • Bolton-Moore C; Centre for Infectious Diseases Research in Zambia, Lusaka, Zambia.
  • Padian N; Division of Infectious Diseases, University of Alabama, Birmingham.
  • Sikazwe I; Division of Epidemiology, University of California, Berkeley.
  • Geng E; Centre for Infectious Diseases Research in Zambia, Lusaka, Zambia.
Clin Infect Dis ; 66(2): 237-243, 2018 01 06.
Article em En | MEDLINE | ID: mdl-29020295
Background: Extending appointment intervals for stable HIV-infected patients in sub-Saharan Africa can reduce patient opportunity costs and decongest overcrowded facilities. Methods: We analyzed a cohort of stable HIV-infected adults (on treatment with CD4 >200 cells/µL for more than 6 months) who presented for clinic visits in Lusaka, Zambia. We used multilevel, mixed-effects logistic regression adjusting for patient characteristics, including prior retention, to assess the association between scheduled appointment intervals and subsequent missed visits (>14 days late to next visit), gaps in medication (>14 days late to next pharmacy refill), and loss to follow-up (LTFU; >90 days late to next visit). Results: A total of 62084 patients (66.6% female, median age 38, median CD4 438 cells/µL) made 501281 visits while stable on antiretroviral therapy. Most visits were scheduled around 1-month (25.0% clinical, 44.4% pharmacy) or 3-month intervals (49.8% clinical, 35.2% pharmacy), with fewer patients scheduled at 6-month intervals (10.3% clinical, 0.4% pharmacy). After adjustment and compared to patients scheduled to return in 1 month, patients with six-month clinic return intervals were the least likely to miss visits (adjusted odds ratio [aOR], 0.20; 95% confidence interval [CI], 0.17-0.24); miss medication pickups (aOR, 0.47; 95% CI 0.39-0.57), and become LTFU prior to the next visit (aOR, 0.41; 95% CI, 0.31-0.54). Conclusions: Six-month clinic return intervals were associated with decreased lateness, gaps in medication, and LTFU in stable HIV-infected patients and may represent a promising strategy to reduce patient burdens and decongest clinics.
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Texto completo: 1 Base de dados: MEDLINE Assunto principal: Infecções por HIV / Fármacos Anti-HIV / Adesão à Medicação / Retenção nos Cuidados Tipo de estudo: Etiology_studies / Incidence_studies / Observational_studies / Risk_factors_studies Limite: Adult / Aged / Female / Humans / Male / Middle aged País como assunto: Africa Idioma: En Ano de publicação: 2018 Tipo de documento: Article

Texto completo: 1 Base de dados: MEDLINE Assunto principal: Infecções por HIV / Fármacos Anti-HIV / Adesão à Medicação / Retenção nos Cuidados Tipo de estudo: Etiology_studies / Incidence_studies / Observational_studies / Risk_factors_studies Limite: Adult / Aged / Female / Humans / Male / Middle aged País como assunto: Africa Idioma: En Ano de publicação: 2018 Tipo de documento: Article