HIV Non-disclosure, Stigma, Incarceration Are Possible Predictors of Poor Follow Up in Research Trials

A collaborative effort between American, Russian and Ukrainian researchers offers new insight into a well-known barrier to high quality, longitudinal HIV research: loss of participant follow up.  This study, led by researchers at the BU Schools of Medicine and Public Health, explored the factors that contributed to attrition in large HIV trial in Russia, a country in which increasing amounts of HIV-related research is being conducted. Their results were published in the June 2014 issue of HIV Clinical Trials.

Any research study that experiences significant loss of participants is at risk for bias: the possibility the missing individuals were not lost randomly.  For example, a medication trial of a 100 people, in which 30 people cannot follow up because they are hospitalized due to severe side effects, will look artificially positive if outcomes data are based on the remaining 70 individuals. Accordingly, the quality of a study will suffer and its findings may be called into question.

This is a particular problem in Russia, as injection drug use (IDU) represents a relatively higher cause of HIV transmission, which has in some studies been associated with factors that negatively impact follow-up: younger age, depression, mental illness, and concomitant alcohol use. However, this has not been a consistent finding, and other relevant factors like HIV non-disclosure status, perceived HIV stigma, and incarceration history have not been thoroughly explored until now.

Tetiana Kiriazova
Tetiana Kiriazova

The researchers analyzed the data from the HIV’s Evolution in Russia – Mitigating Infection Transmission and Alcoholism in a Growing Epidemic (HERMITAGE) study, in which patients were asked to return for six and 12 month assessments.  Of the 660 participants in the study surviving until follow-up, 168 (25.5 percent) did not return for their 12 month follow up visit, and 101 (15.3 percent) never attended any follow-up visit at all, despite extensive retention strategies. Their analysis revealed that participants with current IDU and HIV status non-disclosure missed their first study at approximately 40 percent higher rates than those who did not. They also observed binge drinking was more likely to affect loss to follow up in men than in women, that that a history of incarceration was a stronger predictor of the same in women than in men.

BUSM Postdoctoral Fellow Tetiana Kiriazova, a Ukranian National Institute on Drug Abuse (NIDA) Invest research fellow at the BMC Clinical Addiction Research and Education (CARE) Unit in the department of medicine, and lead author on this study, concluded that “understanding and addressing potential predictor of attrition may improve participant retention in longitudinal clinical research studies of HIV-infected persons, particularly in important but resource-limited research settings.”

Submitted by Ravi Pandit, MD, MPH

 

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