HIV / STI
What happened to people with HIV after they did not show up at a scheduled HIV primary care appointment in 2021-2023? A descriptive analysis of subsequent visit and viremia Sita Lujintanon* Sita Lujintanon Lujintanon Lujintanon Lujintanon Lujintanon Lujintanon Lujintanon Lujintanon Lujintanon Lujintanon Lujintanon Lujintanon Lujintanon Lujintanon Lujintanon Johns Hopkins University
Background
People with HIV (PWH) who miss a scheduled routine HIV care visit may risk adverse outcomes. We describe events after no-show visits among PWH in care at 8 clinics of the CFAR Network of Integrated Clinical System clinical cohort who had ≥1 no-show in-person/telemedicine visit in 2021-2023.
Methods
We examined visit patterns of PWH who (A) attended a subsequent visit, (B) no-showed a subsequent visit, or (C) had no subsequent visit scheduled within 6 months of index no-show visits, stratified by last prior viral load (VL; viral suppression (VS), <200 copies/mL, or viremia, ≥200 copies/mL). We described the proportions of subsequent viremia (≥1 VL ≥200 copies/mL) or no VL test during 1 year after index no-show visits. We weighted each no-show by 1/number of no-shows for each person to draw inference at person level and bootstrapped 95% CI.
Results
There were 23,035 no-show visits from 8,067 PWH (median no-shows/PWH: 2, range: 1-25; median age: 48 (IQR: 37-57); 77% cis-men; 48% non-Hispanic Black; 17% Hispanic; 16% acquired HIV via injection drug use). Most no-show visits were followed by attended visit: 79% (14,714/18,664) with prior VS and 70% (3,044/4,371) with prior viremia. Repeated no-show visits was higher for PWH with prior viremia at 17% (745/4,371) vs. 11% (2,031/18,664) with prior VS as was no subsequent visits scheduled at 13% (582/4,371) vs. 10% (1,919/18,664), respectively. For PWH and prior VS, subsequent viremia was highest among PWH in pattern B (21%; 95% CI: 18-22%), followed by patterns A (14%; 14-15%) and C (10%; 10-12%). For PWH and prior viremia, 51% (95%CI: 50-51%) in A, 40% (39-41%) in B, and 29% (28-29%) in C stayed viremic, but many PWH in B and C had no subsequent VL test (Figure).
Conclusions
PWH who repeatedly no-show regardless of prior VL face higher viremia risk and may require re-engagement and social support (e.g., treatment for substance use) to achieve VS. PWH with no rescheduled visits may have transferred care or died, and warrant further investigation.
