by Carolyn Chu, MD, MSc, AAHIVS, AAHIVM Chief Medical Officer

January 18, 2022

Featured Literature:

Guajardo E, Giordano TP, Westbrook RA, et. al. The Effect of Initial Patient Experiences and Life Stressors on Predicting Lost to Follow-Up in Patients New to an HIV Clinic. AIDS and Behavior. 2022 Jan 5; doi: 10.1007/s10461-021-03539-8. Online ahead of print.

This study aimed to describe and explain the effects of initial patient experiences and life stressors on being lost to follow-up (LTFU) in the first year after establishing HIV care. Authors conducted a prospective cohort study involving 450 adults newly receiving services at a large HIV clinic in the south-central region of the U.S. Enrollment occurred between February 2016 and June 2017. Time since HIV diagnosis was ≤ 3 months for 34.4% of participants, and 19.3% had been living with HIV for > 10 years but were new to the study clinic. Participants completed a 5-item survey regarding experience with their new HIV provider and were also asked if they had experienced certain stressful life events in the preceding 6 months. Investigators also assessed drug/alcohol use, anxiety, depression, social support, and self-efficacy using brief validated measures. Multivariate analyses indicated that patients with better HIV provider experiences at the first visit were significantly less likely to be LTFU (6-mo adjusted OR 0.866 and 12-mo adjusted OR 0.825); additionally, patients with a higher burden of life stressors were significantly more likely to be LTFU (6-month adjusted OR 1.232 and 12-mo adjusted OR 1.263). Exploratory secondary analyses indicated that for patients with CD4 < 200 cells/mm3, patient experience with their provider became more important.

Author’s Commentary:

Findings of this study likely reinforce what many would view as a “common sense” connection between patience experience and HIV outcomes: major life events (e.g. death of loved one, disrupted partnerships, economic destabilization) and poor experiences with providers and/or health care systems can have significant negative impacts on engagement in care. In this cohort, striking rates of recent life changes were observed: over 30% of participants reported death of a close family member or friend, almost 30% reported a change in health insurance, and over 40% reported a loss of income or financial benefits. Although mean overall patient experience score was 8.86 (on a 0-10 scale), significant differences were observed in LTFU based on initial score. Further, authors suggest “it may be that positive experiences [with providers] are particularly important in patients with poorer health status”. As we continue efforts to expedite linkages to care and rapid ART initiation/re-initiation, and in a pandemic environment which has exacerbated hardship for the vast majority of our patients, findings such as these may help shed light on promising practices to establish trust and build relationships with new patients. It also highlights the importance of identifying recent major life stressors, possibly through a standardized approach, to facilitate timely response and support.

The author has no conflicts of interest to disclose.

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