The University of Pennsylvania Medical School recently released an innovative study that looks to change the retention of services for HIV clinical patients. In September, Penn published “Outcomes of HIV-Infected Patients Receiving Care at Multiple Clinics” in AIDS and Behavior. The report, which followed 13,000 HIV patients in Philadelphia, found that participants who received care from multiple HIV clinics were less likely to continue medication and had higher HIV viral loads than those who only visit one clinic. Previous studies have examined outcomes for those in continuous care with those not receiving care, but this is the first of its kind to look at the role that visiting multiple providers can have on one’s health outcomes. The study was led by Dr. Kathleen A. Brady, an infectious-disease physician at Pennsylvania Hospital and medical director/epidemiologist for the city’s AIDS Activities Coordinating Office, as well as Dr. Baligh R. Yehia, assistant professor at Penn’s Division of Infectious Diseases. The study took place between 2008-10 in the 26 Ryan White-funded HIV clinics in Philadelphia and also used data from the city’s Department of Public Health. It examined clonic attendance, as well as use of antiretroviral therapy and HIV viral load suppression to gain findings. Researchers found 1,000 out of 13,000 patients visited numerous clinics and had poorer outcomes than their counterparts. About 69 percent of multiple-clinic visitors received antiretrovirals, and 68 percent suppressed their HIV viral load; in contrast, 83 percent of single-clinic patients received ART, and 79 percent achieved viral-load suppression. The study also found that patients who visited multiple clinics were more likely to be younger, black, female, on public insurance or without insurance and in their first year of care. Yehia said the report sheds light on the importance of developing strong ties with a health-care provider. “If patients are going to more than one clinic, they are more likely to have a weaker patient-doctor relationship,” he said. “They may not be feeling comfortable with their provider.” The study also notes the importance of providers tracking the care their multiple-clinic patients receive so as to reduce the risk of ART medication errors and drug interactions. Yehia said researchers hope to do a more qualitative analysis of the multiple-clinic visitors. “The next step is to talk to patients and see why they are using more than one site. We hope to learn their reasoning — are there more services, an HIV stigma, are some folks looking for narcotic subscription?” he said. “There are a lot of different reasons. Maybe they have a lot of diseases and one doctor helps with one and the other helps with something else. Understanding the next step will help us do better with what services should be provided at these clinics.” Yehia said he hopes the study raises awareness among service providers about keeping an open dialogue with patients about their full medical care. “We want to share this information with providers in the city and let clinics and providers know about our results and give advice on how to check with patients on what other clinics they’re going to.”
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