title: The feasibility of using screening criteria to reduce clinic visits for stable patients on antiretroviral therapy in South Africa.
abstract: OBJECTIVE
  South African HIV care providers are exploring ways to reduce the intensity of patient visits while maintaining high quality of care. We used routinely collected data to model whether a simple screening tool could identify stable patients who would not need to see a doctor during a scheduled medical visit.
  
  
  METHODS
  We identified stable and nonstable visits from January 2007 to September 2011 at a large HIV clinic in Johannesburg, SA. Stable medical visits were defined as having all of the following: stable CD4 count, undetectable viral load, stable weight, not pregnant, no comorbidity, no regimen change within three months, and normal laboratory results for hemoglobin, alanine aminotransferase, and creatinine clearance.
  
  
  METHODS
  We assessed the sensitivity and specificity of nonstable visits at predicting indicators of disease progression or needing additional care: (1) ART regimen change and (2) follow-up visits in <2 and <4 weeks from previous visit.
  
  
  RESULTS
  Stable visits had a sensitivity of 88.9% (95% confidence interval: 88.2 to 89.7) and a specificity of 44.8% (44.5 to 44.1) at predicting ART therapy changes, and a sensitivity of 72.6% (71.8 to 73.4) and specificity of 45.1% (44.8 to 45.4) for predicting a follow-up visit interval of <2 weeks and similar results for predicting a follow-up visit interval of <4 weeks.
  
  
  CONCLUSIONS
  Our retrospective analysis suggests an approach to potentially reduce the number of medical visits while missing few visits in which changes in regimen or additional care would be needed. Evaluation of our criteria in a primary care setting is needed to determine whether they could safely reduce visits.
authors.affiliation: Health Economics and Epidemiology Research Office, Department of Internal Medicine, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa. wmacleod@bu.edu
authors.forename: William B
authors.initials: WB
authors.lastname: MacLeod
authors.forename: Mhairi
authors.initials: M
authors.lastname: Maskew
authors.forename: Imogen
authors.initials: I
authors.lastname: A Jaffray
authors.forename: A Patrick
authors.initials: AP
authors.lastname: MacPhail
authors.forename: Prudence
authors.initials: P
authors.lastname: D Ive
authors.forename: Matthew P
authors.initials: MP
authors.lastname: Fox
mesh_terms: D000328:Adult; D000553:Ambulatory Care / Q000706:statistics & numerical data; D023241:Antiretroviral Therapy, Highly Active; D015415:Biomarkers / Q000032:analysis; D018791:CD4 Lymphocyte Count; D018450:Disease Progression; D005240:Feasibility Studies; D005260:Female; D015658:HIV Infections / Q000175:diagnosis* / Q000188:drug therapy / Q000821:virology; D006801:Humans; D008297:Male; D008403:Mass Screening / Q000379:methods*; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D013019:South Africa; D019562:Viral Load
chemical_list: D015415:Biomarkers