Trends in follow-up visits among people living with HIV - results from the TREAT Asia and Australian HIV Observational Databases (TAHOD and AHOD).

BACKGROUND Less frequent follow-up visits may reduce the burden on people living with HIV (PLHIV) and health facilities. We aimed to assess trends in follow-up visits and survival outcomes among PLHIV in Asia and Australasia. SETTINGS PLHIV enrolled in TAHOD or AHOD from 2008-2017 were included. METHODS Follow-up visits included laboratory testing and clinic visit dates. Visit rates and survival were analysed using repeated measure Poisson regression and competing risk regression, respectively. Additional analyses were limited to stable PLHIV with VL <1000 copies/mL and self-reported adherence ≥95%. RESULTS We included 7707 PLHIV from TAHOD, and 3289 from AHOD. Visit rates were 4.33 per person-years (/PYS) in TAHOD, and 3.68/PYS in AHOD. Both TAHOD and AHOD had decreasing visit rates in later calendar years compared to years 2008-2009 (p<0.001 for both cohorts). Compared to PLHIV with 2 visits, those with ≥4 visits had poorer survival: TAHOD ≥4 visits: sub-hazard ratio (SHR)=1.88, 95%CI 1.16-3.03, p=0.010; AHOD ≥4 visits: SHR=1.80, 95%CI 1.10-2.97, p=0.020; while those with ≤1 visit showed no differences in mortality. The association remained evident among stable PLHIV: TAHOD ≥4 visits: SHR=5.79, 95%CI 1.84-18.24, p=0.003; AHOD ≥4 visits: SHR=2.15, 95%CI 1.20-3.85, p=0.010, compared to 2 visits. CONCLUSIONS Both TAHOD and AHOD visit rates have declined. Less frequent visits did not affect survival outcomes, however poorer health possibly lead to increased follow-up and higher mortality. Reducing visit frequency may be achievable among PLHIV with no other medical complications.