Missed visits and decline in CD4 cell count among HIV-infected patients: A mixed method study

Anna Walburn, Susan Swindells, Christopher Fisher, Robin High, K. M. Islam

Research output: Contribution to journalArticlepeer-review

17 Scopus citations


Objective: To determine the impact of missed visits on CD4 cell count with HIV disease in a Midwest clinic. Methods: This was a mixed method study consisting of a quantitative retrospective cohort study of missed clinic visits among HIV-infected patients, and a qualitative study to collect information on factors impacting appointment attendance. A drop in CD4 cell count greater than 50 cells/mm3 from baseline was the primary outcome variable for the quantitative study. The exposure variable was missed visits. Results: Of 77 patients, 16.4% experienced the outcome of interest. Lower visit proportions increased the risk of a CD4 drop (hazard ratio 0.0188, 95% confidence interval 0.001-0.292). For each 10% increase in the missed visit proportion, the risk of a CD4 drop of >50 cells/mm3 from baseline increased by 33%. Qualitative data suggested that stigma, external support, and physician-patient interactions impacted engagement in care. Conclusion: These results may help providers increase patient motivation and ability to attend clinic appointments.

Original languageEnglish (US)
Pages (from-to)e779-e785
JournalInternational Journal of Infectious Diseases
Issue number11
StatePublished - Nov 2012
Externally publishedYes


  • CD4 count
  • HIV infection
  • Missed visits

ASJC Scopus subject areas

  • Microbiology (medical)
  • Infectious Diseases


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