Retention strategies and factors associated with missed visits among low income women at increased risk of HIV acquisition in the US (HPTN 064).
Women at high-risk for HIV acquisition often face challenges that hinder their retention in HIV prevention trials. These same challenges may contribute to missed clinical care visits among HIV-infected women. This article, informed by the Gelberg-Andersen Behavioral Model for Vulnerable Populations, identifies factors associated with missed study visits and describes the multifaceted retention strategies used by study sites. HPTN 064 was a multisite, longitudinal HIV seroincidence study in 10 US communities. Eligible women were aged 18-44 years, resided in a census tract/zipcode with high poverty and HIV prevalence, and self-reported ≥1 personal or sex partner behavior related to HIV acquisition. Multivariate analyses of predisposing (e.g., substance use) and enabling (e.g., unmet health care needs) characteristics, and study attributes (i.e., recruitment venue, time of enrollment) identified factors associated with missed study visits. Retention strategies included: community engagement; interpersonal relationship building; reduction of external barriers; staff capacity building; and external tracing. Visit completion was 93% and 94% at 6 and 12 months. Unstable housing and later date of enrollment were associated with increased likelihood of missed study visits. Black race, recruitment from an outdoor venue, and financial responsibility for children were associated with greater likelihood of attendance. Multifaceted retention strategies may reduce missed study visits. Knowledge of factors associated with missed visits may help to focus efforts.
1 FHI 360 , Durham, North Carolina.
Danielle F
DF
Haley
Jonathan
J
Lucas
Carol E
CE
Golin
Jing
J
Wang
James P
JP
Hughes
Lynda
L
Emel
Wafaa
W
El-Sadr
Paula M
PM
Frew
Jessica
J
Justman
Adaora A
AA
Adimora
Christopher Chauncey
CC
Watson
Sharon
S
Mannheimer
Anne
A
Rompalo
Lydia
L
Soto-Torres
Zandraetta
Z
Tims-Cook
Yvonne
Y
Carter
Sally L
SL
Hodder
D000293:Adolescent; D000328:Adult; D018791:CD4 Lymphocyte Count; D005260:Female; D015658:HIV Infections / Q000453:epidemiology / Q000517:prevention & control* / Q000628:therapy; D006679:HIV Seropositivity / Q000453:epidemiology* / Q000628:therapy; D015528:HIV Seroprevalence; D006801:Humans; D007398:Interpersonal Relations; D008875:Middle Aged; D009042:Motivation; D015999:Multivariate Analysis; D009819:Office Visits / Q000706:statistics & numerical data*; D010342:Patient Acceptance of Health Care / Q000523:psychology / Q000706:statistics & numerical data*; D010352:Patient Dropouts / Q000706:statistics & numerical data*; D010358:Patient Participation / Q000706:statistics & numerical data*; D015995:Prevalence; D011446:Prospective Studies; D012307:Risk Factors; D012959:Socioeconomic Factors; D013997:Time Factors; D035862:Vulnerable Populations; D055815:Young Adult