title: Racial disparities in HIV virologic failure: do missed visits matter?
abstract: BACKGROUND
  Racial/ethnic health care disparities are well described in people living with HIV/AIDS, although the processes underlying observed disparities are not well elucidated.
  
  
  METHODS
  A retrospective analysis nested in the University of Alabama at Birmingham 1917 Clinic Cohort observational HIV study evaluated patients between August 2004 and January 2007. Factors associated with appointment nonadherence, a proportion of missed outpatient visits, were evaluated. Next, the role of appointment nonadherence in explaining the relationship between African American race and virologic failure (plasma HIV RNA >50 copies/mL) was examined using a staged multivariable modeling approach.
  
  
  RESULTS
  Among 1221 participants, a broad distribution of appointment nonadherence was observed, with 40% of patients missing at least 1 in every 4 scheduled visits. The adjusted odds of appointment nonadherence were 1.85 times higher in African American patients compared with whites [95% confidence interval (CI) = 1.61 to 2.14]. Appointment nonadherence was associated with virologic failure (odds ratio = 1.78, 95% CI = 1.48 to 2.13) and partially mediated the relationship between African American race and virologic failure. African Americans had 1.56 times the adjusted odds of virologic failure (95% CI = 1.19 to 2.05), which declined to 1.30 (95% CI = 0.98 to 1.72) when controlling for appointment nonadherence, a hypothesized mediator.
  
  
  CONCLUSIONS
  Appointment nonadherence was more common in African American patients, associated with virologic failure, and seemed to explain part of observed racial disparities in virologic failure.
authors.affiliation: Division of Infectious Diseases, University of Alabama at Birmingham, Birmingham, AL, USA. mmugavero@uab.edu
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Mugavero
authors.forename: Hui-Yi
authors.initials: HY
authors.lastname: Lin
authors.forename: Jeroan J
authors.initials: JJ
authors.lastname: Allison
authors.forename: Thomas P
authors.initials: TP
authors.lastname: Giordano
authors.forename: James H
authors.initials: JH
authors.lastname: Willig
authors.forename: James L
authors.initials: JL
authors.lastname: Raper
authors.forename: Nelda P
authors.initials: NP
authors.lastname: Wray
authors.forename: Stephen R
authors.initials: SR
authors.lastname: Cole
authors.forename: Joseph E
authors.initials: JE
authors.lastname: Schumacher
authors.forename: Susan
authors.initials: S
authors.lastname: Davies
authors.forename: Michael S
authors.initials: MS
authors.lastname: Saag
mesh_terms: D000328:Adult; D000407:Alabama; D019380:Anti-HIV Agents / Q000627:therapeutic use*; D001071:Appointments and Schedules; D005260:Female; D015658:HIV Infections / Q000188:drug therapy* / Q000208:ethnology / Q000821:virology*; D054625:Healthcare Disparities; D006801:Humans; D008297:Male; D008875:Middle Aged; D010349:Patient Compliance; D044469:Racial Groups; D012189:Retrospective Studies; D012307:Risk Factors
chemical_list: D019380:Anti-HIV Agents