title: The relationship between adherence to clinic appointments and year-one mortality for newly enrolled HIV infected patients at a regional referral hospital in Western Kenya, January 2011-December 2012.
abstract: This retrospective cohort analysis was conducted to describe the association between adherence to clinic appointments and mortality, one year after enrollment into HIV care. We examined appointment-adherence for newly enrolled patients between January 2011 and December 2012 at a regional referral hospital in western Kenya. The outcomes of interest were patient default, risk factors for repeat default, and year-one risk of death. Of 582 enrolled patients, 258 (44%) were defaulters. GEE revealed that once having been defaulters, patients were significantly more likely to repeatedly default (OR 1.4; 95% CI 1.12-1.77), especially the unemployed (OR 1.43; 95% CI 1.07-1.91), smokers (OR 2.22; 95% CI 1.31-3.76), and those with no known disclosure (OR 2.17; 95% CI 1.42-3.3). Nineteen patients (3%) died during the follow-up period. Cox proportional hazards revealed that the risk of death was significantly higher among defaulters (HR 3.12; 95% CI 1.2-8.0) and increased proportionally to the rate of patient default; HR was 4.05 (95% CI1.38-11.81) and 4.98 (95% CI 1.45-17.09) for a cumulative of 4-60 and ≥60 days elapsed between all scheduled and actual clinic appointment dates, respectively. Risk factors for repeat default suggest a need to deliver targeted adherence programs.
authors.affiliation: a Global Programs for Research and Training , University of California , San Francisco , Nairobi , Kenya.
authors.forename: Muthusi
authors.initials: M
authors.lastname: Kimeu
authors.affiliation: b HIV Implementation Science and Services Kenya Medical Research Institute/Centers for Global Health Research (KEMRI,CGHR) , Kisumu , Kenya.
authors.forename: Barbara
authors.initials: B
authors.lastname: Burmen
authors.affiliation: b HIV Implementation Science and Services Kenya Medical Research Institute/Centers for Global Health Research (KEMRI,CGHR) , Kisumu , Kenya.
authors.forename: Beryl
authors.initials: B
authors.lastname: Audi
authors.affiliation: b HIV Implementation Science and Services Kenya Medical Research Institute/Centers for Global Health Research (KEMRI,CGHR) , Kisumu , Kenya.
authors.forename: Anne
authors.initials: A
authors.lastname: Adega
authors.affiliation: b HIV Implementation Science and Services Kenya Medical Research Institute/Centers for Global Health Research (KEMRI,CGHR) , Kisumu , Kenya.
authors.forename: Karen
authors.initials: K
authors.lastname: Owuor
authors.affiliation: c HIV Comprehensive Care Centre , Jaramogi Oginga Odinga Teaching and Referral Hospital , Kisumu , Kenya.
authors.forename: Susan
authors.initials: S
authors.lastname: Arodi
authors.affiliation: b HIV Implementation Science and Services Kenya Medical Research Institute/Centers for Global Health Research (KEMRI,CGHR) , Kisumu , Kenya.
authors.forename: Dennis
authors.initials: D
authors.lastname: Bii
authors.affiliation: d Surveillance and Epidemiology Branch , CDC Division of Global HIV AIDS , Kisumu , Kenya.
authors.forename: Emily
authors.initials: E
authors.lastname: Zielinski-Gutiérrez
mesh_terms: D000328:Adult; D001071:Appointments and Schedules; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D015658:HIV Infections / Q000401:mortality* / Q000523:psychology; D006801:Humans; D007630:Kenya; D008297:Male; D008875:Middle Aged; D009819:Office Visits / Q000706:statistics & numerical data*; D010349:Patient Compliance; D016016:Proportional Hazards Models; D012017:Referral and Consultation; D012189:Retrospective Studies; D012307:Risk Factors; D062606:Tertiary Care Centers / Q000706:statistics & numerical data*
keywords: Compliance; HIV/AIDS; adherence; outcome; survival