Asuncion Diaz1, Alicia Ten2, Henar Marcos3, Gonzalo Gutiérrez4, Juan González-García5, Santiago Moreno6, Ana María Barrios7, Sari Arponen8, Álvaro Portillo9, Regino Serrano10, Maria Teresa García11, José Luis Pérez12, Javier Toledo13, Maria Carmen Royo14, Gustavo González15, Ana Izquierdo16, Luis Javier Viloria17, Irene López18, Lázaro Elizalde19, Eva Martínez20, Daniel Castrillejo21, Rosa Aranguren22, Caridad Redondo23, Mercedes Diez24. 1. Área de Vigilancia del VIH y comportamientos de riesgo, Centro Nacional de Epidemiología, Instituto de Salud Carlos III, Madrid, España; CIBER Epidemiología y Salud Pública (CIBERESP), Ministerio de Ciencia e Innovación, Instituto de Salud Carlos III, Madrid, España. Electronic address: adiaz@isciii.es. 2. Plan sida, Servicio de Promoción y Protección de Salud, Subdirección General de Promoción de la Salud y Prevención, DG salud pública, Conselleria de Sanidad de Valencia, Valencia, España. 3. Servicio de Vigilancia Epidemiológica y Enfermedades Transmisibles, DG de Salud Pública, Consejería de Sanidad de Castilla y León, Valladolid, España. 4. Servicio de Epidemiología, DG de Salud Pública, Consejería de Sanidad de Castilla-La Mancha, Toledo, España. 5. Servicio de Medicina Interna, Hospital Universitario La Paz, Madrid, España. 6. Servicio de Enfermedades Infecciosas, Hospital Universitario Ramón y Cajal, Madrid, España. 7. Servicio de Medicina Interna, Hospital de Fuenlabrada, Madrid, España. 8. Servicio de Medicina Interna, Hospital Universitario de Torrejón, Madrid, España. 9. Servicio de Medicina Interna, Hospital Infanta Elena, Madrid, España. 10. Servicio de Medicina Interna, Hospital Universitario del Henares, Madrid, España. 11. Servicio de Medicina Interna, Hospital del Sureste, Madrid, España. 12. Servicio de Medicina Interna, Hospital Universitario Infanta Cristina, Madrid, España. 13. Coordinación de VIH/sida, Servicio de Promoción de la Salud y Prevención de la Enfermedad, DG de Salud Pública de Aragón, Zaragoza, España. 14. Servicio de Evaluación de la Salud y Programas, DG de Salud Pública, Consejería de Sanidad, Asturias, Oviedo, España. 15. Oficina de Coordinación VIH de Extremadura, Servicio de Participación Comunitaria en Salud, DG de Salud Pública, Servicio Extremeño de Salud, Mérida, Extremadura, España. 16. Servicio de Epidemiología y Promoción de la Salud, DG de Salud Pública, Servicio Canario de la Salud, Santa Cruz de Tenerife, Canarias, España. 17. Sección de Vigilancia Epidemiológica, DG de Salud Pública, Santander, Cantabria, España. 18. Servicio de Prevención y Epidemiología del Plan sobre sida, Consejería de Sanidad y Consumo, Ceuta, España. 19. Sección de Promoción de Salud, Instituto de Salud Pública y Laboral, Pamplona, Navarra, España. 20. Sección de Vigilancia Epidemiológica y Control de Enfermedades Transmisibles, DG de Salud Pública y Consumo, Logroño, La Rioja, España. 21. Servicio de Epidemiología, DG de Sanidad y Consumo, Consejería de Bienestar Social y Sanidad, Melilla, España. 22. Coordinación Autonómica de Drogas y de la Estrategia de Sida, DG de Salut Pública i Consum, Conselleria de Salut, Família i Bienestar Social, Palma, Baleares, España. 23. Hospital Universitario Virgen de la Arrixaca, Murcia, España. 24. Área de Vigilancia del VIH y comportamientos de riesgo, Centro Nacional de Epidemiología, Instituto de Salud Carlos III, Madrid, España; CIBER Epidemiología y Salud Pública (CIBERESP), Ministerio de Ciencia e Innovación, Instituto de Salud Carlos III, Madrid, España; Plan Nacional sobre el Sida, SG de Promoción de la Salud y Epidemiología, Ministerio de Sanidad, Servicios Sociales e Igualdad, Madrid, España.
Abstract
INTRODUCTION: To describe the occurrence of non-regular attendance to follow-up visits among HIV patients and to analyze the determining factors. METHODS: One-day survey carried out annually (2002-2012) in public hospitals. Epidemiological, clinical and behavioral data are collected in all HIV-infected inpatients and outpatients receiving HIV-related care on the day of the survey. "Non-regular attendance to a follow-up visit" was defined as sporadic attendance to the medical appointments, according to the judgment of the attending physician. Descriptive and bivariate analyses were performed, and factors associated to non-regular attendance to follow-up visits were estimated using logistic regression. RESULTS: A total of 7,304 subjects were included, of whom 13.7% did not attend medical appointments regularly. Factors directly associated with non-regular attendance were: age between 25-49 years; birth in Sub-Saharan Africa or Latin-America; low educational level; being homeless or in prison; living alone or in closed institutions; being unemployed or retired; being an intravenous drug user; not using a condom at last sexual encounter, and injecting drugs in the last 30 days. Conversely, HIV diagnosis within the last year and being men who have sex with men were factors inversely associated with non-regular attendance to follow-up visits. CONCLUSION: In spite of health care beings free of charge for everyone in Spain, social factors can act as barriers to regular attendance to medical appointments, which, in turn, can endanger treatment effectiveness in some population groups. This should be taken into account when planning HIV policies in Spain.
INTRODUCTION: To describe the occurrence of non-regular attendance to follow-up visits among HIV patients and to analyze the determining factors. METHODS: One-day survey carried out annually (2002-2012) in public hospitals. Epidemiological, clinical and behavioral data are collected in all HIV-infected inpatients and outpatients receiving HIV-related care on the day of the survey. "Non-regular attendance to a follow-up visit" was defined as sporadic attendance to the medical appointments, according to the judgment of the attending physician. Descriptive and bivariate analyses were performed, and factors associated to non-regular attendance to follow-up visits were estimated using logistic regression. RESULTS: A total of 7,304 subjects were included, of whom 13.7% did not attend medical appointments regularly. Factors directly associated with non-regular attendance were: age between 25-49 years; birth in Sub-Saharan Africa or Latin-America; low educational level; being homeless or in prison; living alone or in closed institutions; being unemployed or retired; being an intravenous drug user; not using a condom at last sexual encounter, and injecting drugs in the last 30 days. Conversely, HIV diagnosis within the last year and being men who have sex with men were factors inversely associated with non-regular attendance to follow-up visits. CONCLUSION: In spite of health care beings free of charge for everyone in Spain, social factors can act as barriers to regular attendance to medical appointments, which, in turn, can endanger treatment effectiveness in some population groups. This should be taken into account when planning HIV policies in Spain.
Keywords:
AIDS; Human immunodeficiency virus; Loss of follow-up; Pérdidas de seguimiento; Retención en cuidados; Retention in care; Sida; Virus de la inmunodeficiencia humana