The Contribution of Missed Clinic Visits to Disparities in HIV Viral Load Outcomes.
OBJECTIVE
We explored the contribution of missed primary HIV care visits ("no-show") to observed disparities in virological failure (VF) among Black persons and persons with injection drug use (IDU) history.


METHODS
We used patient-level data from 6 academic clinics, before the Centers for Disease Control and Prevention and Health Resources and Services Administration Retention in Care intervention. We employed staged multivariable logistic regression and multivariable models stratified by no-show visit frequency to evaluate the association of sociodemographic factors with VF. We used multiple imputations to assign missing viral load values.


RESULTS
Among 10 053 patients (mean age = 46 years; 35% female; 64% Black; 15% with IDU history), 31% experienced VF. Although Black patients and patients with IDU history were significantly more likely to experience VF in initial analyses, race and IDU parameter estimates were attenuated after sequential addition of no-show frequency. In stratified models, race and IDU were not statistically significantly associated with VF at any no-show level.


CONCLUSIONS
Because missed clinic visits contributed to observed differences in viral load outcomes among Black and IDU patients, achieving an improved understanding of differential visit attendance is imperative to reducing disparities in HIV.
Anne Zinski, Andrew O. Westfall, D. Scott Batey, and Michael J. Mugavero are with the Department of Medicine, Division of Infectious Diseases, University of Alabama at Birmingham. Lytt I. Gardner is with the Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, GA. Thomas P. Giordano is with the Department of Medicine, Section of Infectious Diseases, Baylor College of Medicine, Houston, TX. Tracey E. Wilson is with the Department of Community Health Sciences, State University of New York, Downstate Medical Center, Brooklyn, NY. Mari-Lynn Drainoni is with the Department of Health Policy and Management, Boston University School of Public Health, Boston, MA. Jeanne C. Keruly is with Johns Hopkins University, School of Medicine, Division of Infectious Diseases, Baltimore, MD. Allan E. Rodriguez is with the Division of Infectious Diseases, Miller School of Medicine, University of Miami, FL. Faye Malitz is with the HIV/AIDS Bureau, Health Resources and Services Administration, Rockville, MD.
Anne
A
Zinski
Anne Zinski, Andrew O. Westfall, D. Scott Batey, and Michael J. Mugavero are with the Department of Medicine, Division of Infectious Diseases, University of Alabama at Birmingham. Lytt I. Gardner is with the Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, GA. Thomas P. Giordano is with the Department of Medicine, Section of Infectious Diseases, Baylor College of Medicine, Houston, TX. Tracey E. Wilson is with the Department of Community Health Sciences, State University of New York, Downstate Medical Center, Brooklyn, NY. Mari-Lynn Drainoni is with the Department of Health Policy and Management, Boston University School of Public Health, Boston, MA. Jeanne C. Keruly is with Johns Hopkins University, School of Medicine, Division of Infectious Diseases, Baltimore, MD. Allan E. Rodriguez is with the Division of Infectious Diseases, Miller School of Medicine, University of Miami, FL. Faye Malitz is with the HIV/AIDS Bureau, Health Resources and Services Administration, Rockville, MD.
Andrew O
AO
Westfall
Anne Zinski, Andrew O. Westfall, D. Scott Batey, and Michael J. Mugavero are with the Department of Medicine, Division of Infectious Diseases, University of Alabama at Birmingham. Lytt I. Gardner is with the Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, GA. Thomas P. Giordano is with the Department of Medicine, Section of Infectious Diseases, Baylor College of Medicine, Houston, TX. Tracey E. Wilson is with the Department of Community Health Sciences, State University of New York, Downstate Medical Center, Brooklyn, NY. Mari-Lynn Drainoni is with the Department of Health Policy and Management, Boston University School of Public Health, Boston, MA. Jeanne C. Keruly is with Johns Hopkins University, School of Medicine, Division of Infectious Diseases, Baltimore, MD. Allan E. Rodriguez is with the Division of Infectious Diseases, Miller School of Medicine, University of Miami, FL. Faye Malitz is with the HIV/AIDS Bureau, Health Resources and Services Administration, Rockville, MD.
Lytt I
LI
Gardner
Anne Zinski, Andrew O. Westfall, D. Scott Batey, and Michael J. Mugavero are with the Department of Medicine, Division of Infectious Diseases, University of Alabama at Birmingham. Lytt I. Gardner is with the Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, GA. Thomas P. Giordano is with the Department of Medicine, Section of Infectious Diseases, Baylor College of Medicine, Houston, TX. Tracey E. Wilson is with the Department of Community Health Sciences, State University of New York, Downstate Medical Center, Brooklyn, NY. Mari-Lynn Drainoni is with the Department of Health Policy and Management, Boston University School of Public Health, Boston, MA. Jeanne C. Keruly is with Johns Hopkins University, School of Medicine, Division of Infectious Diseases, Baltimore, MD. Allan E. Rodriguez is with the Division of Infectious Diseases, Miller School of Medicine, University of Miami, FL. Faye Malitz is with the HIV/AIDS Bureau, Health Resources and Services Administration, Rockville, MD.
Thomas P
TP
Giordano
Anne Zinski, Andrew O. Westfall, D. Scott Batey, and Michael J. Mugavero are with the Department of Medicine, Division of Infectious Diseases, University of Alabama at Birmingham. Lytt I. Gardner is with the Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, GA. Thomas P. Giordano is with the Department of Medicine, Section of Infectious Diseases, Baylor College of Medicine, Houston, TX. Tracey E. Wilson is with the Department of Community Health Sciences, State University of New York, Downstate Medical Center, Brooklyn, NY. Mari-Lynn Drainoni is with the Department of Health Policy and Management, Boston University School of Public Health, Boston, MA. Jeanne C. Keruly is with Johns Hopkins University, School of Medicine, Division of Infectious Diseases, Baltimore, MD. Allan E. Rodriguez is with the Division of Infectious Diseases, Miller School of Medicine, University of Miami, FL. Faye Malitz is with the HIV/AIDS Bureau, Health Resources and Services Administration, Rockville, MD.
Tracey E
TE
Wilson
Anne Zinski, Andrew O. Westfall, D. Scott Batey, and Michael J. Mugavero are with the Department of Medicine, Division of Infectious Diseases, University of Alabama at Birmingham. Lytt I. Gardner is with the Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, GA. Thomas P. Giordano is with the Department of Medicine, Section of Infectious Diseases, Baylor College of Medicine, Houston, TX. Tracey E. Wilson is with the Department of Community Health Sciences, State University of New York, Downstate Medical Center, Brooklyn, NY. Mari-Lynn Drainoni is with the Department of Health Policy and Management, Boston University School of Public Health, Boston, MA. Jeanne C. Keruly is with Johns Hopkins University, School of Medicine, Division of Infectious Diseases, Baltimore, MD. Allan E. Rodriguez is with the Division of Infectious Diseases, Miller School of Medicine, University of Miami, FL. Faye Malitz is with the HIV/AIDS Bureau, Health Resources and Services Administration, Rockville, MD.
Mari-Lynn
ML
Drainoni
Anne Zinski, Andrew O. Westfall, D. Scott Batey, and Michael J. Mugavero are with the Department of Medicine, Division of Infectious Diseases, University of Alabama at Birmingham. Lytt I. Gardner is with the Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, GA. Thomas P. Giordano is with the Department of Medicine, Section of Infectious Diseases, Baylor College of Medicine, Houston, TX. Tracey E. Wilson is with the Department of Community Health Sciences, State University of New York, Downstate Medical Center, Brooklyn, NY. Mari-Lynn Drainoni is with the Department of Health Policy and Management, Boston University School of Public Health, Boston, MA. Jeanne C. Keruly is with Johns Hopkins University, School of Medicine, Division of Infectious Diseases, Baltimore, MD. Allan E. Rodriguez is with the Division of Infectious Diseases, Miller School of Medicine, University of Miami, FL. Faye Malitz is with the HIV/AIDS Bureau, Health Resources and Services Administration, Rockville, MD.
Jeanne C
JC
Keruly
Anne Zinski, Andrew O. Westfall, D. Scott Batey, and Michael J. Mugavero are with the Department of Medicine, Division of Infectious Diseases, University of Alabama at Birmingham. Lytt I. Gardner is with the Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, GA. Thomas P. Giordano is with the Department of Medicine, Section of Infectious Diseases, Baylor College of Medicine, Houston, TX. Tracey E. Wilson is with the Department of Community Health Sciences, State University of New York, Downstate Medical Center, Brooklyn, NY. Mari-Lynn Drainoni is with the Department of Health Policy and Management, Boston University School of Public Health, Boston, MA. Jeanne C. Keruly is with Johns Hopkins University, School of Medicine, Division of Infectious Diseases, Baltimore, MD. Allan E. Rodriguez is with the Division of Infectious Diseases, Miller School of Medicine, University of Miami, FL. Faye Malitz is with the HIV/AIDS Bureau, Health Resources and Services Administration, Rockville, MD.
Allan E
AE
Rodriguez
Anne Zinski, Andrew O. Westfall, D. Scott Batey, and Michael J. Mugavero are with the Department of Medicine, Division of Infectious Diseases, University of Alabama at Birmingham. Lytt I. Gardner is with the Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, GA. Thomas P. Giordano is with the Department of Medicine, Section of Infectious Diseases, Baylor College of Medicine, Houston, TX. Tracey E. Wilson is with the Department of Community Health Sciences, State University of New York, Downstate Medical Center, Brooklyn, NY. Mari-Lynn Drainoni is with the Department of Health Policy and Management, Boston University School of Public Health, Boston, MA. Jeanne C. Keruly is with Johns Hopkins University, School of Medicine, Division of Infectious Diseases, Baltimore, MD. Allan E. Rodriguez is with the Division of Infectious Diseases, Miller School of Medicine, University of Miami, FL. Faye Malitz is with the HIV/AIDS Bureau, Health Resources and Services Administration, Rockville, MD.
Faye
F
Malitz
Anne Zinski, Andrew O. Westfall, D. Scott Batey, and Michael J. Mugavero are with the Department of Medicine, Division of Infectious Diseases, University of Alabama at Birmingham. Lytt I. Gardner is with the Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, GA. Thomas P. Giordano is with the Department of Medicine, Section of Infectious Diseases, Baylor College of Medicine, Houston, TX. Tracey E. Wilson is with the Department of Community Health Sciences, State University of New York, Downstate Medical Center, Brooklyn, NY. Mari-Lynn Drainoni is with the Department of Health Policy and Management, Boston University School of Public Health, Boston, MA. Jeanne C. Keruly is with Johns Hopkins University, School of Medicine, Division of Infectious Diseases, Baltimore, MD. Allan E. Rodriguez is with the Division of Infectious Diseases, Miller School of Medicine, University of Miami, FL. Faye Malitz is with the HIV/AIDS Bureau, Health Resources and Services Administration, Rockville, MD.
D Scott
DS
Batey
Anne Zinski, Andrew O. Westfall, D. Scott Batey, and Michael J. Mugavero are with the Department of Medicine, Division of Infectious Diseases, University of Alabama at Birmingham. Lytt I. Gardner is with the Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, GA. Thomas P. Giordano is with the Department of Medicine, Section of Infectious Diseases, Baylor College of Medicine, Houston, TX. Tracey E. Wilson is with the Department of Community Health Sciences, State University of New York, Downstate Medical Center, Brooklyn, NY. Mari-Lynn Drainoni is with the Department of Health Policy and Management, Boston University School of Public Health, Boston, MA. Jeanne C. Keruly is with Johns Hopkins University, School of Medicine, Division of Infectious Diseases, Baltimore, MD. Allan E. Rodriguez is with the Division of Infectious Diseases, Miller School of Medicine, University of Miami, FL. Faye Malitz is with the HIV/AIDS Bureau, Health Resources and Services Administration, Rockville, MD.
Michael J
MJ
Mugavero
D001741:Black or African American; D001071:Appointments and Schedules; D005260:Female; D015658:HIV Infections / Q000188:drug therapy* / Q000208:ethnology; D006801:Humans; D008297:Male; D008875:Middle Aged; D010349:Patient Compliance; D012307:Risk Factors; D012959:Socioeconomic Factors; D019966:Substance-Related Disorders / Q000453:epidemiology; D014481:United States / Q000453:epidemiology; D019562:Viral Load