Experts Say Visits to Multiple HIV Clinics is Bad

According to a new study published in the journal "AIDS and Behavior," patients who received care at multiple HIV clinics rather than just one were less likely to take their medication and had higher HIV viral loads.

"It's about retention in care, but also continuity, two related but distinct processes," said senior author Kathleen A. Brady, MD, an infectious disease physician at Pennsylvania Hospital and Medical Director/Medical Epidemiologist for the Philadelphia Department of Public Health's AIDS Activities Coordinating Office. "This paper helps to describe a group of patients in whom there is duplication of services, but who also have worse outcomes. I'm hopeful that by providing this data to HIV clinicians, we can get a better understanding of why patients see multiple providers and make improvements to the system to achieve these goals."

The study looked at almost 13,000 HIV patients in Philadelphia from Penn Medicine to find that continuous care with one health care provider or clinic was optimal for HIV outcomes, and reducing transmission. It could even cut down on duplicate services that contribute to higher health care costs.

Brady, along with Baligh R. Yehia, MD, MPP, MSHP, an assistant professor in the division of Infectious Diseases at the Perelman School of Medicine at the University of Pennsyvlania, found that almost a thousand of the 13,000 patients visited multiple HIV clinics and had poorer outcomes.

They were less likely to maintain adherence to their anti-retroviral regimens and had poorer outcomes. In the course of the study, 69 percent of patients who visited multiple clinics received ART, as compared with 83 percent of patients receiving care at a single clinic. The single-clinic patients had a higher viral suppression rate.

Those patients who visited multiple clinics were more likely to be young, black, women, uninsured, and in their first year of care. But the pattern of multiple clinic use continued every year for 20 percent of these patients.

This shows a schism between the idea of a patient being "retained" in care by national standards even if they are visiting multiple clinics, and the effect that can have on health. The outcome is invariably a lower standard of health with a higher price tag.

"In times of diminishing resources, identifying ways to maximize resources and improve HIV outcomes is essential," said Brady.

Researchers said that next on the agenda is to establish an understanding of why these patients jump from clinic to clinic -- among them shame, denial, stigma and gaps in coverage.

"Next, researchers should focus on better understanding the reasons behind multiple clinics visit, which could run the gamut," said Yehia. "Difficulty accepting the diagnosis and coping with stigma may play a role. Many people may move onto another clinic because of comorbidity, like hepatitis C and mental health treatments, which may not be offered at all clinics. Patient-provider interactions may also play a role. All of this information will help us better understand patient behaviors, which can help us improve HIV care."