Identifying Barriers to Routine Lab Follow Up in HIV Patients

Routine lab follow-up is imperative for HIV patients. At the Comprehensive Care Clinic, our interdisciplinary team includes a pharmacy practitioner, a physician, a and counseling professional to help provide the most guideline HIV-based care while in the clinic.
At the CCC, our team noticed a lack of follow-up to labs increases resource use and provider burden in determining care plans. The percentage of patients that did not have appropriate lab follow-up increased significantly during the COVID pandemic. Identifying patient barriers to lab follow-up at the CCC can help optimize resource use and determine an accurate number of virally undetectable patients at the clinic.
The project consisted of two phases. Phase one identified which patients had not followed up to labs from September 2020 - August 2021 but were still refilling their medications. 156 patients were identified. Phase two consisted of calling patients and screening for the barriers that were identified in the chart review and reminding them of the importance of labs in planning treatment. Patient charts were reviewed one-month post phone call to determine if labs had been completed.
Of the 108 patients called, 56% of patients answered and were screened for barriers to lab follow-up. 25% of patients had recently followed up to labs, just outside of the three-month time period. 20% of patients had relocated out of the area or established care elsewhere. 49% percent of patients without lab follow-up had been in care for 10 or more years. Of the patients who were reminded to follow-up, 45% of patients had labs drawn within a one-month period.
Most of the patients who had not had labs drawn within a two-month period had been in care for over 5-10 years. This indicates that many patients are aware of the need for labs, but may not feel a sense of urgency within the appropriate follow-up window. Additionally, when compared to overall clinic demographics, this population had more women, patients with mental health conditions, and patients with substance use history.
The most pertinent barriers to labs affecting this patient population include re-establishing care elsewhere, forgetfulness, and issues with insurance. Future work would include clear documentation in patient charts of transferred care and closer follow-up with social work when insurance issues arise. The findings of this study were shared with VCCC staff, and providers were reminded of the importance of emphasizing laboratory follow-up for all patients.