Outcomes of HIV-infected patients receiving care at multiple clinics.
Receiving care at multiple clinics may compromise the therapeutic patient-provider alliance and adversely affect the treatment of people living with HIV. We evaluated 12,759 HIV-infected adults in Philadelphia, PA between 2008 and 2010 to determine the effects of using multiple clinics for primary HIV care. Using generalized estimating equations with logistic regression, we examined the relationship between receiving care at multiple clinics (≥ 1 visit to two or more clinics during a calendar year) and two outcomes: (1) use of ART and (2) HIV viral load ≤ 200 copies/mL for patients on ART. Overall, 986 patients (8 %) received care at multiple clinics. The likelihood of attending multiple clinics was greater for younger patients, women, blacks, persons with public insurance, and for individuals in their first year of care. Adjusting for sociodemographic factors, patients receiving care at multiple clinics were less likely to use ART (AOR = 0.62, 95 % CI 0.55-0.71) and achieve HIV viral suppression (AOR = 0.78, 95 % CI 0.66-0.94) than individuals using one clinic. Qualitative data are needed to understand the reasons for visiting multiple clinics.
Baligh R
BR
Yehia
Asher J
AJ
Schranz
Florence
F
Momplaisir
Sara C
SC
Keller
Robert
R
Gross
Ian
I
Frank
Joshua P
JP
Metlay
Kathleen A
KA
Brady
D000328:Adult; D000553:Ambulatory Care / Q000523:psychology / Q000706:statistics & numerical data*; D000554:Ambulatory Care Facilities / Q000458:organization & administration*; D019380:Anti-HIV Agents / Q000627:therapeutic use*; D018791:CD4 Lymphocyte Count; D015331:Cohort Studies; D003266:Continuity of Patient Care / Q000458:organization & administration*; D005260:Female; D015658:HIV Infections / Q000188:drug therapy* / Q000453:epidemiology / Q000523:psychology; D006801:Humans; D008297:Male; D017063:Outcome Assessment, Health Care; D010349:Patient Compliance / Q000523:psychology / Q000706:statistics & numerical data*; D015143:Philadelphia / Q000453:epidemiology; D012189:Retrospective Studies; D012648:Self Care / Q000523:psychology* / Q000706:statistics & numerical data; D019562:Viral Load
D019380:Anti-HIV Agents