Mody A., Roy M., Sikombe K., Savory T., Holmes C.B., Bolton-Moore C., Padian N., Sikazwe I., Geng E.
Extending appointment intervals for stable HIV-infected patients in sub-Saharan Africa can reduce patient opportunity costs and decongest overcrowded facilities.
We analyzed a cohort of stable HIV-infected adults (on treatment with CD4>200 cells/μl for over 6 months) presenting for clinic visits in Lusaka, Zambia. We utilized multilevel, mixed-effects logistic regression adjusting for patient characteristics—including prior retention—to assess the association between scheduled appointment intervals and subsequent missed visits (>14 days late to next visit), gaps in medication (>14 days late to next pharmacy refill), and loss to follow-up (LTFU, >90 days late to next visit).
62,084 patients (66.6% female, median age 38, median CD4 438 cells/μl) made 501,281 visits while stable on ART. Most visits were scheduled around 1 month (25.0% clinical, 44.4% pharmacy) or 3 month intervals (49.8% clinical, 35.2% pharmacy), with fewer patients scheduled at 6 month intervals (10.3% clinical, 0.4% pharmacy). After adjustment and as compared to patients scheduled to return in 1 month, patients with longer clinic return intervals were less likely to miss visits (6m aOR 0.20 [95% CI 0.17–0.24]); 3m aOR 0.50 [95% CI 0.49–0.52]; miss medication pickups (6m aOR 0.47 [95% CI 0.39–0.57]; 3m aOR 0.69 [95% CI 0.67–0.70]), and become LTFU prior to the next visit (6m aOR 0.41 [95% CI 0.31–0.54]; 3m aOR 0.79 [95% CI 0.76–0.82]).
Six month clinic return intervals were associated with decreased lateness, gaps in medication, and LTFU in stable HIV-infected patients and may represent a promising strategy to reduce patient burdens and decongest clinics.