Routine HIV clinic visit adherence in the African Cohort Study
Authors: Dear Nicole , Esber Allahna , Iroezindu Michael , Bahemana Emmanuel , Kibuuka Hannah , Maswai Jonah , Owuoth John , Polyak Christina S. , Ake Julie A. , Crowell Trevor A. ,   the AFRICOS Study Group, Bartolanzo Danielle , Reynolds Alexus , Song Katherine , Milazzo Mark , Francisco Leilani , Mankiewicz Shauna , Schech Steven , Golway Alexandra , Omar Badryah , Mebrahtu Tsedal , Lee Elizabeth , Bohince Kimberly , Parikh Ajay , Hern Jaclyn , Duff Emma , Lombardi Kara , Imbach Michelle , Eller Leigh Anne , Kibuuka Hannah , Semwogerere Michael , Naluyima Prossy , Zziwa Godfrey , Tindikahwa Allan , Mutebe Hilda , Kafeero Cate , Baghendaghe Enos , Lwebuge William , Ssentogo Freddie , Birungi Hellen , Tegamanyi Josephine , Wangiri Paul , Nabanoba Christine , Namulondo Phiona , Tumusiime Richard , Musingye Ezra , Nanteza Christina , Wandege Joseph , Waiswa Michael , Najjuma Evelyn , Maggaga Olive , Kenoly Isaac Kato , Mukanza Barbara , Maswai Jonah , Langat Rither , Ngeno Aaron , Korir Lucy , Langat Raphael , Opiyo Francis , Kasembeli Alex , Ochieng Christopher , Towett Japhet , Kimetto Jane , Omondi Brighton , Leelgo Mary , Obonyo Michael , Rotich Linner , Tonui Enock , Chelangat Ella , Kapkiai Joan , Wangare Salome , Kesi Zeddy Bett , Ngeno Janet , Langat Edwin , Labosso Kennedy , Rotich Joshua , Cheruiyot Leonard , Changwony Enock , Bii Mike , Chumba Ezekiel , Ontango Susan , Gitonga Danson , Kiprotich Samuel , Ngtech Bornes , Engoke Grace , Metet Irene , Airo Alice , Kiptoo Ignatius , Owuoth John , Sing’oei Valentine , Rehema Winne , Otieno Solomon , Ogari Celine , Modi Elkanah , Adimo Oscar , Okwaro Charles , Lando Christine , Onyango Margaret , Aoko Iddah , Obambo Kennedy , Meyo Joseph , Suja George , Iroezindu Michael , Adamu Yakubu , Azuakola Nnamdi , Asuquo Mfreke , Tiamiyu Abdulwasiu Bolaji , Kokogho Afoke , Mohammed Samirah Sani , Okoye Ifeanyi , Odeyemi Sunday , Suleiman Aminu , Umejo Lawrence , Enas Onome , Mbachu Miriam , Chigbu-Ukaegbu Ijeoma , Adai Wilson , Odo Felicia Anayochukwu , Abdu Rabi , Akiga Rosemary , Nwandu Helen , Okolo CHisara , Okeke Ndubuisis , Parker Zahra , Linus Asogwa Ugochukwu , Agbaim Concilia Amaka , Adegbite Tunde , Harrison Nkenchiere , Adelakun Adewale , Chioma Ekeocha , Idi Victoria , Eluwa Rachel , Nwalozie Jumoke , Faith Igiri , Okanigbuan Blessing , Emmanuel Achugwo , Nnadi Nkiru , Rosemary Ndubuisi , Natalie Uzoegwu Amaka , Owanza Obende Theresa , Francis Falaju Idowu , Elemere Jacintal , Lauretta Obilor Ifeoma , Akinwale Edward , Ochai Inalegwu , Maganga Lucas , Bahemana Emmanuel , Khamadi Samoel , Njegite John , Lueer Connie , Kisinda Abisai , Mwamwaja Jaquiline , Mbwayu Faraja , David Gloria , Mwaipopo Mtasi , Gervas Reginald , Mkondoo Doroth , Somi Nancy , Kiliba Paschal , Mwaisanga Gwamaka , Msigwa Johnisius , Mfumbulwa Hawa , Edwin Peter , Olomi Willyhelmina 
Published: January 2022

Abstract
Background
Retention in clinical care is important for people living with HIV (PLWH). Evidence suggests that missed clinic visits are associated with interruptions in antiretroviral therapy (ART), lower CD4 counts, virologic failure, and overlooked coinfections. We identified factors associated with missed routine clinic visits in the African Cohort Study (AFRICOS).

Methods
In 2013, AFRICOS began enrolling people with and without HIV in Uganda, Kenya, Tanzania, and Nigeria. At enrollment and every 6 months thereafter, sociodemographic questionnaires are administered and clinical outcomes assessed. Missed clinic visits were measured as the self-reported number of clinic visits missed in the past 6 months and dichotomized into none or one or more visits missed. Logistic regression with generalized estimating equations was used to estimate odds ratios (ORs) and 95% confidence intervals (CIs) for associations between risk factors and missed visits.

Results
Between January 2013 and March 2020, 2937 PLWH were enrolled, of whom 2807 (95.6%) had initiated ART and 2771 had complete data available for analyses. Compared to PLWH 50+, missed clinic visits were more common among those 18–29 years (aOR 2.33, 95% CI 1.65–3.29), 30–39 years (aOR 1.59, 95% CI 1.19–2.13), and 40–49 years (aOR 1.42, 95% CI 1.07–1.89). As compared to PLWH on ART for < 2 years, those on ART for 4+ years were less likely to have missed clinic visits (aOR 0.72, 95% CI 0.55–0.95). Missed clinic visits were associated with alcohol use (aOR 1.34, 95% CI 1.05–1.70), a history of incarceration (aOR 1.42, 95% CI 1.07–1.88), depression (aOR 1.47, 95% CI 1.13–1.91), and viral non-suppression (aOR 2.50, 95% CI 2.00–3.12). As compared to PLWH who did not miss any ART in the past month, missed clinic visits were more common among those who missed 1–2 days (aOR 2.09, 95% CI 1.65–2.64) and 3+ days of ART (aOR 7.06, 95% CI 5.43–9.19).

Conclusions
Inconsistent clinic attendance is associated with worsened HIV-related outcomes. Strategies to improve visit adherence are especially needed for young PLWH and those with depression.