title: Association between missed early visits and mortality among patients of china national free antiretroviral treatment cohort.
abstract: BACKGROUND
  China's National Free Antiretroviral Treatment program has scaled-up rapidly since 2002, leading to a significant reduction of mortality among its participants. However, few studies have evaluated indicators for patient access to medical care and their association with mortality.
  
  
  METHODS
  Patients enrolled into this national program between June 2002 and June 2009 for at least 7.5 months were retrospectively analyzed.
  
  
  RESULTS
  Twenty-seven thousand five hundred four patients were included into the analysis, among whom 10,034 (37%) had at least 1 missed visit during the first 6 months of treatment. In Cox proportional hazard regression analysis, controlled for baseline demographic and clinical factors, patients with more missed visits had a higher risk of mortality, with an adjusted hazard ratio of 1.3 (95% confidence interval: 1.1 to 1.5) for 1-2 missed visits and 1.7 (95% confidence interval 1.4 to 2.2) for ≥3 missed visits compared with patients with no missed visits. In multivariate logistic regression models, factors independently associated with a higher likelihood of early missed visits included female gender, age >60, HIV transmission via injection drug use or via plasma donation compared with sexual transmission, baseline alanine aminotransferase >100 IU/L, having more symptoms at antiretroviral therapy initiation and receiving a didanosine-based regimen compared with lamivudine-based regimen. Lower baseline CD4 count was protective against missed visits.
  
  
  CONCLUSIONS
  Missing early visits occurred in a sizable number of patients in this cohort and was associated with a higher mortality rate. Early missed visits may serve as an early warning indicator to trigger additional outreach effort.
authors.affiliation: Division of Treatment and Care, National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, PR China.
authors.forename: Yao
authors.initials: Y
authors.lastname: Zhang
authors.forename: Zhihui
authors.initials: Z
authors.lastname: Dou
authors.forename: Kai
authors.initials: K
authors.lastname: Sun
authors.forename: Ye
authors.initials: Y
authors.lastname: Ma
authors.forename: Ray Y
authors.initials: RY
authors.lastname: Chen
authors.forename: Marc
authors.initials: M
authors.lastname: Bulterys
authors.forename: Yan
authors.initials: Y
authors.lastname: Zhao
authors.forename: Hao
authors.initials: H
authors.lastname: Zhu
authors.forename: Zhongfu
authors.initials: Z
authors.lastname: Liu
authors.forename: Fujie
authors.initials: F
authors.lastname: Zhang
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019380:Anti-HIV Agents / Q000008:administration & dosage*; D002681:China; D015331:Cohort Studies; D005260:Female; D015658:HIV Infections / Q000175:diagnosis* / Q000188:drug therapy / Q000401:mortality*; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D016019:Survival Analysis; D055815:Young Adult
chemical_list: D019380:Anti-HIV Agents