title: Risk factors for missed HIV primary care visits among men who have sex with men.
abstract: Benefits of anti-retroviral therapy (ART) depend on consistent HIV care attendance. However, appointment non-adherence (i.e. missed appointments) is common even in programs that reduce financial barriers. Demographic, health/treatment, and psychosocial contributors to appointment non-adherence were examined among men who have sex with men (MSM) attending HIV primary care. Participants (n = 503) completed questionnaires, and HIV biomarker data were extracted from medical records. At 12 months, records were reviewed to assess HIV primary care appointment non-adherence. Among MSM, 31.2% missed without cancellation at least one appointment during 12-month study period. Independent predictors (P < 0.05) were: low income (OR = 1.87); African American (OR = 3.00) and Hispanic/Latino (OR = 4.31) relative to non-Hispanic White; depression (OR = 2.01); and low expectancy for appointments to prevent/treat infection (OR = 2.38), whereas private insurance (OR = 0.48) and older age (OR = 0.94) predicted lower risk. Low self-efficacy predicted marginal risk (OR = 2.74, P = 0.10). The following did not independently predict risk for non-adherence: education, relationship status, general health, time since HIV diagnosis, ART history, post-traumatic stress disorder, HIV stigma, or supportive clinic staff. Appointment non-adherence is prevalent, particularly among younger and racial/ethnic minority MSM. Socioeconomic barriers, depression and low appointment expectancy and self-efficacy may be targets to increase care engagement.
authors: Behavioral Medicine Service, Massachusetts General Hospital/Harvard Medical School, Boston, MA 02114, USA. LTRAEGER@partners.org
authors: Lara
authors: L
authors: Traeger
authors: Conall
authors: C
authors: O'Cleirigh
authors: Margie R
authors: MR
authors: Skeer
authors: Kenneth H
authors: KH
authors: Mayer
authors: Steven A
authors: SA
authors: Safren
mesh_terms: D000328:Adult; D000367:Age Factors; D015658:HIV Infections / Q000208:ethnology / Q000628:therapy*; D018451:Homosexuality, Male; D006801:Humans; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D010349:Patient Compliance; D011320:Primary Health Care / Q000706:statistics & numerical data*; D012307:Risk Factors; D020377:Self Efficacy; D012923:Social Class