Evaluation of Longitudinal Clinical Outcomes and Adherence to Care among HIV-Infected Refugees

• Published in: Journal of the International Association of Providers of AIDS Care Vol. 12; no. 3; pp. 202 - 207
• Main Authors: Winston, Susanna E., Montague, Brian T., Lopez, Michael J., Delong, Allison, LeMarchand, Chloe, Bedoya, Armando, Gillani, Fizza S., Beckwith, Curt G.
• Format: Journal Article
• Language: English
• Published: Los Angeles, CA SAGE Publications 01.05.2013; SAGE PUBLICATIONS, INC; SAGE Publishing
• Subjects: Adolescent; Adult; Africa South of the Sahara - ethnology; Aged; Anti-HIV Agents - therapeutic use; Antiretroviral drugs; Appointments and Schedules; Clinical outcomes; Female; Health Knowledge, Attitudes, Practice; HIV; HIV Infections - ethnology; HIV Infections - psychology; HIV Infections - therapy; Human immunodeficiency virus; Humans; Longitudinal Studies; Male; Medical treatment; Middle Aged; Patient Compliance; Refugees; Resistance; Socioeconomic Factors; Support services; Treatment compliance; Treatment Outcome; Treatment outcomes; United States - epidemiology; Young Adult; Africa South of the Sahara; United States; clinic adherence; sub-Saharan Africa; HIV; postsuppression viremia; refugee
• ISSN: 2325-9574; 2325-9582; 2325-9582
• DOI: 10.1177/1545109712459680

Background: HIV-infected refugees resettled in the United States face many challenges. Longitudinal data regarding HIV-specific outcomes in this population are limited. Methods: We reviewed charts of 51 HIV-infected sub-Saharan African refugees matched to 102 nonrefugees. Outcomes analyzed included CD4 counts, viral loads (VLs), antiretroviral treatment (ART) use, appointment adherence, opportunistic infections, and resistance mutations. Results: The ART initiation was similar. Appointment adherence was similar in year 1, but refugees were significantly less adherent beyond year 3. Refugees and nonrefugees spent similar amounts of time in care suppressed (83% vs 80%, P = .93). Refugees had higher odds of viremia following undetectable VL (OR 2.3, P < .05). Discussion: Initially, sub-Saharan African HIV-infected refugees have comparable appointment adherence, ART use, and VL suppression to nonrefugees. Overtime refugees were less adherent to appointments and more likely to have postsuppression viremia. The support services provided to refugees early in care may be important for retention in care and treatment success.