Missed Visits and Mortality among Patients Establishing Initial Outpatient HIV Treatment

作者：Michael J. Mugavero, Hui‐Yi Lin, James H. Willig, Andrew O. Westfall, Kimberly B. Ulett, Justin S. Routman, Sarah Abroms, James L. Raper, Michael S. Saag, Jeroan J. Allison · 发表于：Clinical Infectious Diseases · 年份：2008 · DOI：10.1086/595705 · 被引用次数：484 · 研究领域：HIV/AIDS Research and Interventions、HIV Research and Treatment、HIV/AIDS drug development and treatment

BACKGROUND: Dramatic increases in the number of patients requiring linkage to treatment for human immunodeficiency virus (HIV) infection are anticipated in response to updated Centers for Disease Control and Prevention HIV testing recommendations that advocate routine, opt-out HIV testing. METHODS: A retrospective analysis nested within a prospective HIV clinical cohort study evaluated patients who established initial outpatient treatment for HIV infection at the University of Alabama at Birmingham 1917 HIV/AIDS Clinic from 1 January 2000 through 31 December 2005. Survival methods were used to evaluate the impact of missed visits during the first year of care on subsequent mortality in the context of other baseline sociodemographic, psychosocial, and clinical factors. Mortality was ascertained by query of the Social Security Death Index as of 1 August 2007. RESULTS: Among 543 study participants initiating outpatient care for HIV infection, 60% missed a visit within the first year. The mortality rate was 2.3 deaths per 100 person-years for patients who missed visits, compared with 1.0 deaths per 100 person-years for those who attended all scheduled appointments during the first year after establishing outpatient treatment (P = .02). In Cox proportional hazards analysis, higher hazards of death were independently associated with missed visits (hazard ratio, 2.90; 95% confidence interval, 1.28-6.56), older age (hazard ratio, 1.58 per 10 years of age; 95% confidence interval, 1.1...