Using Fewer Clinics May Be Better for HIV Care

HIV infected people using multiple care clinics found to have worse treatment and disease outcomes

(RxWiki News) Reliable and consistent care for HIV-infected people is a necessity. Using multiple care centers for treatment may not allow patients to get the right amount or kind of care.

A recent study examined the effect of getting HIV care at multiple clinics on disease management and treatment in HIV-infected people.

The researchers found that patients who got care at multiple clinics each year were less likely to use necessary treatment and reduce the amount of HIV virus in their bodies compared to patients who used only one clinic per year.

The researchers concluded that patients who use multiple clinics per year for care run the risk of treatment errors because the different clinics may not have the same information on a patient. These patients also might contribute to higher public healthcare costs because of repetitive and unnecessary services, according to the researchers.

"Tell your healthcare provider about all HIV treatments."

The lead author of this study was Baligh R. Yehia, MD, MPP, MSHP, from the Department of Medicine of the Perelman School of Medicine at the University of Pennsylvania in Philadelphia.

The researchers looked at 12,759 HIV-infected patients from 26 HIV clinics in Philadelphia between January 1, 2008 and December 31, 2010. The participants were all 18 years of age or older and had to have had two primary HIV visits and one CD4 test within a calendar year. CD4 cells are white blood cells which the HIV virus attacks.

A primary HIV visit was considered to be a visit to an outpatient HIV care clinic that has the authority to prescribe HIV medication.

There were three groups of multiple clinic visitation patterns: 1) patients who visited a second clinic only once, 2) patients who transferred their care to another clinic and 3) patients who alternated between clinics for care.

The researchers found that 986 patients (8 percent) had received care from more than one HIV clinic. In 2008, 328 patients were found to be using more than one HIV clinic. In 2009, 428 patients were using more than one HIV clinic, and 393 patients were using more than one clinic in 2010.

The researchers found that the patients who alternated between multiple clinics for care were significantly more likely to have gotten HIV from injecting drugs, more likely to have a larger number of care visits per year, less likely to be using antiretroviral therapy (ART), less likely to be in their first year of care during the study and less likely to significantly reduce the amount of HIV virus in their bodies compared to the other groups.

The researchers also discovered that patients in their first year of care were five times as likely to use multiple clinics in a year compared to patients already in care. In addition, patients between the ages of 40 and 49 years old had a 24 percent decreased likelihood of using multiple clinics in a year, and those aged 50 and over had a 34 percent decreased likelihood compared to the younger participants.

Over the whole study period, the researchers found that 69 percent of the participants using multiple clinics for care used ART, and 68 percent were able to reduce their HIV viral count. Out of the participants using only one clinic for care, 83 percent were using ART, and 78 percent were able to achieve viral reduction.

The researchers explained that the participants who used multiple clinics had a 38 percent decreased likelihood of using ART, and a 22 percent decreased likelihood of reducing their viral count compared to the single-clinic participants.

Ultimately, the researchers suggest that the findings on the multiple clinic population in this study should be important to HIV care providers because incomplete or improper documentation of care from other clinics could lead to another clinic making errors with ART such as dangerous drug interactions and side effects.

The researchers also believe that these findings should be important to public healthcare officials because patients who used multiple clinics for care may receive repetitive or unnecessary services, potentially raising the costs of HIV health care. In addition, using multiple clinics for care can affect how public health departments monitor, track, and regulate standard care for HIV-infected people.

The authors mentioned a few limitations.

First, the study was based on data collected before the study period, so the researchers were not able to interview participants about the reasons for using multiple clinics. Second, the participant population came from an urban area of one city, so the findings cannot be generalized to all areas.

Third, it's possible that some of the participants used clinics that were not included in this study, so the percentage of patients using multiple clinics could be underestimated. Fourth, the study did not include data on factors that may have influenced the use of multiple clinics, such as co-occuring conditions, prescription mediation or type of services used by a patient.

This study was published in the September edition of AIDS and Behavior.

The Penn Center for AIDS Research and the National Institutes of Health provided funding.

Review Date: 
October 10, 2013