Barriers to Follow-up Care for People Living With HIV and Neurologic Symptoms
Nithyashri Baskaran1, Gerome Vallejos1, Aprajita Bhorkar1, Alexandra Diaz-Ariza1, Jason Zucker2, Simian Huang2, Kiran Thakur1, Kathryn Holroyd1
1Neurology, 2Infectious Disease, Columbia University Irving Medical Center
Objective:
Identify barriers to follow-up care for people living with HIV (PLWH) and neurologic symptoms.
Background:
HIV can cause a range of nervous system complications which may persist even in those with viral suppression. Understanding barriers to neurologic follow-up is a necessary step towards better supporting PLWH.
Design/Methods:
2,545 patients admitted to Columbia University Irving Medical Center with a positive HIV-1 or HIV-2 ELISA antibody assay from 1/1/2018 until 2/28/2025 were identified. Patients were screened for neurologic consult and/or admission notes or orders, from which 100 patients were identified. Chart review of these patients identified demographic data, HIV laboratory parameters, HIV duration, final neurologic diagnosis, modified Rankin scale at discharge, and follow-up up to one year after admission. Logistic regression analyses were conducted to determine which parameters significantly correlated with follow-up attendance for a subset of 78 patients who had a final neurologic diagnosis and were not deceased or referred to hospice at discharge.
Results:
Of the subset of 78 patients, 24 (30.8%) attended follow-up; 24 (30.8%) had no referral, 14 (17.9%) had referral but no appointment made, 16 (20.5%) had referral and appointment made but did not attend. In univariate analyses of 14 parameters, HIV duration >5 years was significantly associated with higher odds of attending follow-up (OR 2.81, 95% CI 1.10–7.44, p = 0.03). In the adjusted multivariate model with 8 parameters, no factors were significantly associated with clinic attendance. HIV duration >5 years trended towards higher odds of attendance (OR 2.66, 95% CI 0.79 – 8.91, p = 0.11) while substance use history trended towards lower odds (OR 0.35, 95% CI 0.08 – 1.49, p = 0.16).
Conclusions:
A minority of PLWH and neurologic symptoms who warrant follow-up successfully engage with follow-up. Standardized practices for referral and appointment scheduling are necessary to bridge gaps in follow-up care for PLWH and neurologic symptoms.
Disclaimer: Abstracts were not reviewed by Neurology® and do not reflect the views of Neurology® editors or staff.