Missed visits and decline in CD4 cell count among HIV-infected patients: a mixed method study.
OBJECTIVE
To determine the impact of missed visits on CD4 cell count with HIV disease in a Midwest clinic.


METHODS
This was a mixed method study consisting of a quantitative retrospective cohort study of missed clinic visits among HIV-infected patients, and a qualitative study to collect information on factors impacting appointment attendance. A drop in CD4 cell count greater than 50 cells/mm(3) from baseline was the primary outcome variable for the quantitative study. The exposure variable was missed visits.


RESULTS
Of 77 patients, 16.4% experienced the outcome of interest. Lower visit proportions increased the risk of a CD4 drop (hazard ratio 0.0188, 95% confidence interval 0.001-0.292). For each 10% increase in the missed visit proportion, the risk of a CD4 drop of >50 cells/mm(3) from baseline increased by 33%. Qualitative data suggested that stigma, external support, and physician-patient interactions impacted engagement in care.


CONCLUSIONS
These results may help providers increase patient motivation and ability to attend clinic appointments.
Epi Data Center Department, Navy and Marine Corps Public Health Center, Portsmouth, Virginia, USA.
Anna
A
Walburn
Susan
S
Swindells
Christopher
C
Fisher
Robin
R
High
K M
KM
Islam
D000328:Adult; D000368:Aged; D018791:CD4 Lymphocyte Count; D015331:Cohort Studies; D005260:Female; D015658:HIV Infections / Q000276:immunology* / Q000821:virology; D015497:HIV-1 / Q000302:isolation & purification*; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D008875:Middle Aged; D009329:Nebraska; D010342:Patient Acceptance of Health Care; D016016:Proportional Hazards Models; D012189:Retrospective Studies