Abstract
Benefits of anti-retroviral therapy (ART) depend on consistent HIV care attendance. However, appointment non-adherence (i.e.
missed appointments) is common even in programs that reduce financial barriers. Demographic, health/treatment, and psychosocial
contributors to appointment non-adherence were examined among men who have sex with men (MSM) attending HIV primary care.
Participants (n = 503) completed questionnaires, and HIV biomarker data were extracted from medical records. At 12 months,
records were reviewed to assess HIV primary care appointment non-adherence. Among MSM, 31.2% missed without cancellation at
least one appointment during 12-month study period. Independent predictors (P < 0.05) were: low income (OR = 1.87); African American (OR = 3.00) and Hispanic/Latino (OR = 4.31) relative to non-Hispanic
White; depression (OR = 2.01); and low expectancy for appointments to prevent/treat infection (OR = 2.38), whereas private
insurance (OR = 0.48) and older age (OR = 0.94) predicted lower risk. Low self-efficacy predicted marginal risk (OR = 2.74,
P = 0.10). The following did not independently predict risk for non-adherence: education, relationship status, general health,
time since HIV diagnosis, ART history, post-traumatic stress disorder, HIV stigma, or supportive clinic staff. Appointment
non-adherence is prevalent, particularly among younger and racial/ethnic minority MSM. Socioeconomic barriers, depression
and low appointment expectancy and self-efficacy may be targets to increase care engagement.
missed appointments) is common even in programs that reduce financial barriers. Demographic, health/treatment, and psychosocial
contributors to appointment non-adherence were examined among men who have sex with men (MSM) attending HIV primary care.
Participants (n = 503) completed questionnaires, and HIV biomarker data were extracted from medical records. At 12 months,
records were reviewed to assess HIV primary care appointment non-adherence. Among MSM, 31.2% missed without cancellation at
least one appointment during 12-month study period. Independent predictors (P < 0.05) were: low income (OR = 1.87); African American (OR = 3.00) and Hispanic/Latino (OR = 4.31) relative to non-Hispanic
White; depression (OR = 2.01); and low expectancy for appointments to prevent/treat infection (OR = 2.38), whereas private
insurance (OR = 0.48) and older age (OR = 0.94) predicted lower risk. Low self-efficacy predicted marginal risk (OR = 2.74,
P = 0.10). The following did not independently predict risk for non-adherence: education, relationship status, general health,
time since HIV diagnosis, ART history, post-traumatic stress disorder, HIV stigma, or supportive clinic staff. Appointment
non-adherence is prevalent, particularly among younger and racial/ethnic minority MSM. Socioeconomic barriers, depression
and low appointment expectancy and self-efficacy may be targets to increase care engagement.
- Content Type Journal Article
- Pages 1-9
- DOI 10.1007/s10865-011-9383-z
- Authors
- Lara Traeger, Behavioral Medicine Service, Massachusetts General Hospital/Harvard Medical School, One Bowdoin Square, 7th Floor, Boston, MA 02114, USA
- Conall O’Cleirigh, Behavioral Medicine Service, Massachusetts General Hospital/Harvard Medical School, One Bowdoin Square, 7th Floor, Boston, MA 02114, USA
- Margie R. Skeer, Fenway Institute, Fenway Health, Boston, MA, USA
- Kenneth H. Mayer, Fenway Institute, Fenway Health, Boston, MA, USA
- Steven A. Safren, Behavioral Medicine Service, Massachusetts General Hospital/Harvard Medical School, One Bowdoin Square, 7th Floor, Boston, MA 02114, USA
- Journal Journal of Behavioral Medicine
- Online ISSN 1573-3521
- Print ISSN 0160-7715