April 15, 2011
Moving Can Be Hazardous to Your Health
HIV-positive people who moved to a new location outside the range of their HIV clinic had poorer health than those who stayed in care within the clinic, according to a study published in the May 1 issue of the Journal of Acquired Immune Deficiency Syndromes.
In real-world HIV care, one of the most troubling situations for health care providers is losing touch with their patients. In some clinics, substantial proportions (sometimes exceeding 30 percent) of people leave care without explanation and without giving providers a way to track their future health, what health care experts call “lost to follow-up.”
Studies have demonstrated that when such individuals return to care at a particular clinic or are located later at another clinic, they are often in much poorer shape than people who remain in care. There are often characteristics of people who are lost to follow-up, however, that exacerbate poor health. These include more frequent drug use, incarceration, mental illness and homelessness.
One group of people who’ve been studied less thoroughly are those who make a planned move and whose care can be tracked in some way. To better understand how such individuals fare after a move, Hartmut Krentz, PhD, and his colleagues from the University of Calgary, in Canada, studied the medical records of 836 people receiving care in the Southern Alberta region of Canada. One benefit of studying people with HIV in Canada is that the country had universal health care and universal access to HIV care, thus eliminating one of the biggest barriers to continuous care for people in the United States.
Krentz and his team compared those who stayed in care within the Southern Alberta system, those who were lost to follow-up and returned, and those who made a planned move and who later returned to care. The characteristics of those who remained in care was similar to those who left care at some point, except that those who left care tended to be younger and healthier when they entered HIV care: on average they had higher CD4 count and fewer AIDS diagnoses.
Overall, those who left care fared much more poorly than those who remained in care, no matter their reason for leaving. People who stayed in care saw their CD4 cells increase from an average of 288 to 460. By contrast, those who were lost to follow-up and then returned saw their CD4s drop from 405 to 270. Of concern, however, was the fact that even those who planned a move suffered negative health consequences—their CD4s also fell, from 424 to 339. People who left care and then returned also had twice the rate of new AIDS diagnoses as those who stayed in care.
The authors acknowledge that their study size is small and that there might be factors associated with those who moved that would predispose them to poorer health outcomes than those who stayed in care. Nevertheless, the fact that those with a planned move did almost as poorly as those who were simply lost to follow-up does indicate that even a planned move can be detrimental.
The authors state that they suspect that the primary reason for poorer health outcomes in those who moved was either discontinuing their antiretroviral (ARV) medication or failing to get on medication later if their CD4 cells dropped.
In any respect, Hertz and his colleagues strongly recommend that people with HIV and their providers try hard to seek out care in advance for those who may be moving and to make the transition to a new clinic as seamless as possible.
Search: Moving, health, HIV clinic, continuous care, lost to follow-up, Hartmut Krentz, Calgary, Alberta, Canada
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