Racial disparities in HIV virologic failure: Do missed visits matter?

Research output: Contribution to journalArticle

Michael J. Mugavero, Hui Yi Lin, Jeroan J. Allison, Thomas P. Giordano, James H. Willig, James L. Raper, Nelda Wray, Stephen R. Cole, Joseph E. Schumacher, Susan Davies, Michael S. Saag

BACKGROUND: Racial/ethnic health care disparities are well described in people living with HIV/AIDS, although the processes underlying observed disparities are not well elucidated. METHODS: A retrospective analysis nested in the University of Alabama at Birmingham 1917 Clinic Cohort observational HIV study evaluated patients between August 2004 and January 2007. Factors associated with appointment nonadherence, a proportion of missed outpatient visits, were evaluated. Next, the role of appointment nonadherence in explaining the relationship between African American race and virologic failure (plasma HIV RNA >50 copies/mL) was examined using a staged multivariable modeling approach. RESULTS: Among 1221 participants, a broad distribution of appointment nonadherence was observed, with 40% of patients missing at least 1 in every 4 scheduled visits. The adjusted odds of appointment nonadherence were 1.85 times higher in African American patients compared with whites [95% confidence interval (CI) = 1.61 to 2.14]. Appointment nonadherence was associated with virologic failure (odds ratio = 1.78, 95% CI = 1.48 to 2.13) and partially mediated the relationship between African American race and virologic failure. African Americans had 1.56 times the adjusted odds of virologic failure (95% CI = 1.19 to 2.05), which declined to 1.30 (95% CI = 0.98 to 1.72) when controlling for appointment nonadherence, a hypothesized mediator. CONCLUSIONS: Appointment nonadherence was more common in African American patients, associated with virologic failure, and seemed to explain part of observed racial disparities in virologic failure.

Original languageEnglish (US)
Pages (from-to)100-108
Number of pages9
JournalJournal of Acquired Immune Deficiency Syndromes
Volume50
Issue number1
DOIs
StatePublished - Jan 1 2009

PMID: 19295340

PMCID: PMC2766510

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Racial disparities in HIV virologic failure : Do missed visits matter? / Mugavero, Michael J.; Lin, Hui Yi; Allison, Jeroan J.; Giordano, Thomas P.; Willig, James H.; Raper, James L.; Wray, Nelda; Cole, Stephen R.; Schumacher, Joseph E.; Davies, Susan; Saag, Michael S.

In: Journal of Acquired Immune Deficiency Syndromes, Vol. 50, No. 1, 01.01.2009, p. 100-108.

Research output: Contribution to journalArticle

Harvard

Mugavero, MJ, Lin, HY, Allison, JJ, Giordano, TP, Willig, JH, Raper, JL, Wray, N, Cole, SR, Schumacher, JE, Davies, S & Saag, MS 2009, 'Racial disparities in HIV virologic failure: Do missed visits matter?' Journal of Acquired Immune Deficiency Syndromes, vol. 50, no. 1, pp. 100-108. https://doi.org/10.1097/QAI.0b013e31818d5c37

APA

Mugavero, M. J., Lin, H. Y., Allison, J. J., Giordano, T. P., Willig, J. H., Raper, J. L., ... Saag, M. S. (2009). Racial disparities in HIV virologic failure: Do missed visits matter? Journal of Acquired Immune Deficiency Syndromes, 50(1), 100-108. https://doi.org/10.1097/QAI.0b013e31818d5c37

Vancouver

Mugavero MJ, Lin HY, Allison JJ, Giordano TP, Willig JH, Raper JL et al. Racial disparities in HIV virologic failure: Do missed visits matter? Journal of Acquired Immune Deficiency Syndromes. 2009 Jan 1;50(1):100-108. https://doi.org/10.1097/QAI.0b013e31818d5c37

Author

Mugavero, Michael J. ; Lin, Hui Yi ; Allison, Jeroan J. ; Giordano, Thomas P. ; Willig, James H. ; Raper, James L. ; Wray, Nelda ; Cole, Stephen R. ; Schumacher, Joseph E. ; Davies, Susan ; Saag, Michael S. / Racial disparities in HIV virologic failure : Do missed visits matter?. In: Journal of Acquired Immune Deficiency Syndromes. 2009 ; Vol. 50, No. 1. pp. 100-108.

BibTeX

@article{82f9456e7a1646329d69ccb5a08e0a81,
title = "Racial disparities in HIV virologic failure: Do missed visits matter?",
abstract = "BACKGROUND: Racial/ethnic health care disparities are well described in people living with HIV/AIDS, although the processes underlying observed disparities are not well elucidated. METHODS: A retrospective analysis nested in the University of Alabama at Birmingham 1917 Clinic Cohort observational HIV study evaluated patients between August 2004 and January 2007. Factors associated with appointment nonadherence, a proportion of missed outpatient visits, were evaluated. Next, the role of appointment nonadherence in explaining the relationship between African American race and virologic failure (plasma HIV RNA >50 copies/mL) was examined using a staged multivariable modeling approach. RESULTS: Among 1221 participants, a broad distribution of appointment nonadherence was observed, with 40{\%} of patients missing at least 1 in every 4 scheduled visits. The adjusted odds of appointment nonadherence were 1.85 times higher in African American patients compared with whites [95{\%} confidence interval (CI) = 1.61 to 2.14]. Appointment nonadherence was associated with virologic failure (odds ratio = 1.78, 95{\%} CI = 1.48 to 2.13) and partially mediated the relationship between African American race and virologic failure. African Americans had 1.56 times the adjusted odds of virologic failure (95{\%} CI = 1.19 to 2.05), which declined to 1.30 (95{\%} CI = 0.98 to 1.72) when controlling for appointment nonadherence, a hypothesized mediator. CONCLUSIONS: Appointment nonadherence was more common in African American patients, associated with virologic failure, and seemed to explain part of observed racial disparities in virologic failure.",
keywords = "Access to care, Adherence, Disparities, HIV/AIDS, Mediation",
author = "Mugavero, {Michael J.} and Lin, {Hui Yi} and Allison, {Jeroan J.} and Giordano, {Thomas P.} and Willig, {James H.} and Raper, {James L.} and Nelda Wray and Cole, {Stephen R.} and Schumacher, {Joseph E.} and Susan Davies and Saag, {Michael S.}",
year = "2009",
month = "1",
day = "1",
doi = "10.1097/QAI.0b013e31818d5c37",
language = "English (US)",
volume = "50",
pages = "100--108",
journal = "Journal of Acquired Immune Deficiency Syndromes",
issn = "1525-4135",
publisher = "Lippincott Williams and Wilkins",
number = "1",

}

RIS

TY - JOUR

T1 - Racial disparities in HIV virologic failure

T2 - Journal of Acquired Immune Deficiency Syndromes

AU - Mugavero, Michael J.

AU - Lin, Hui Yi

AU - Allison, Jeroan J.

AU - Giordano, Thomas P.

AU - Willig, James H.

AU - Raper, James L.

AU - Wray, Nelda

AU - Cole, Stephen R.

AU - Schumacher, Joseph E.

AU - Davies, Susan

AU - Saag, Michael S.

PY - 2009/1/1

Y1 - 2009/1/1

N2 - BACKGROUND: Racial/ethnic health care disparities are well described in people living with HIV/AIDS, although the processes underlying observed disparities are not well elucidated. METHODS: A retrospective analysis nested in the University of Alabama at Birmingham 1917 Clinic Cohort observational HIV study evaluated patients between August 2004 and January 2007. Factors associated with appointment nonadherence, a proportion of missed outpatient visits, were evaluated. Next, the role of appointment nonadherence in explaining the relationship between African American race and virologic failure (plasma HIV RNA >50 copies/mL) was examined using a staged multivariable modeling approach. RESULTS: Among 1221 participants, a broad distribution of appointment nonadherence was observed, with 40% of patients missing at least 1 in every 4 scheduled visits. The adjusted odds of appointment nonadherence were 1.85 times higher in African American patients compared with whites [95% confidence interval (CI) = 1.61 to 2.14]. Appointment nonadherence was associated with virologic failure (odds ratio = 1.78, 95% CI = 1.48 to 2.13) and partially mediated the relationship between African American race and virologic failure. African Americans had 1.56 times the adjusted odds of virologic failure (95% CI = 1.19 to 2.05), which declined to 1.30 (95% CI = 0.98 to 1.72) when controlling for appointment nonadherence, a hypothesized mediator. CONCLUSIONS: Appointment nonadherence was more common in African American patients, associated with virologic failure, and seemed to explain part of observed racial disparities in virologic failure.

AB - BACKGROUND: Racial/ethnic health care disparities are well described in people living with HIV/AIDS, although the processes underlying observed disparities are not well elucidated. METHODS: A retrospective analysis nested in the University of Alabama at Birmingham 1917 Clinic Cohort observational HIV study evaluated patients between August 2004 and January 2007. Factors associated with appointment nonadherence, a proportion of missed outpatient visits, were evaluated. Next, the role of appointment nonadherence in explaining the relationship between African American race and virologic failure (plasma HIV RNA >50 copies/mL) was examined using a staged multivariable modeling approach. RESULTS: Among 1221 participants, a broad distribution of appointment nonadherence was observed, with 40% of patients missing at least 1 in every 4 scheduled visits. The adjusted odds of appointment nonadherence were 1.85 times higher in African American patients compared with whites [95% confidence interval (CI) = 1.61 to 2.14]. Appointment nonadherence was associated with virologic failure (odds ratio = 1.78, 95% CI = 1.48 to 2.13) and partially mediated the relationship between African American race and virologic failure. African Americans had 1.56 times the adjusted odds of virologic failure (95% CI = 1.19 to 2.05), which declined to 1.30 (95% CI = 0.98 to 1.72) when controlling for appointment nonadherence, a hypothesized mediator. CONCLUSIONS: Appointment nonadherence was more common in African American patients, associated with virologic failure, and seemed to explain part of observed racial disparities in virologic failure.

KW - Access to care

KW - Adherence

KW - Disparities

KW - HIV/AIDS

KW - Mediation

UR - http://www.scopus.com/inward/record.url?scp=64249084639&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=64249084639&partnerID=8YFLogxK

U2 - 10.1097/QAI.0b013e31818d5c37

DO - 10.1097/QAI.0b013e31818d5c37

M3 - Article

VL - 50

SP - 100

EP - 108

JO - Journal of Acquired Immune Deficiency Syndromes

JF - Journal of Acquired Immune Deficiency Syndromes

SN - 1525-4135

IS - 1

ER -

ID: 2353861