Abstract
Background: We examine attrition and Loss To Follow Up (LTFU) and their baseline predictors among HIVinfected children and adolescents in a Community Home-Based Care (CHBC) model in Kampala (Uganda). Methods: We conducted a retrospective cohort analysis of attrition and LTFU and their predictors among children and adolescents aged 0-20 years in the Tukula Fenna project. The project operates at the Home Care Department of Nsambya Hospital and four outreach clinics, located in Kampala and three surrounding districts in Uganda. The project uses community home-based care to provide free Antiretroviral Therapy (ART), other medical treatment as necessary, nutritional support, psychosocial support, and home visits. Kaplan-Meier curves were used to assess attrition and LTFU, and multivariate Cox proportional hazard regression models were used to identify their predictors. Results: 1162 children and adolescents with confirmed positive HIV status were enrolled in the Tukula Fenna project between October 2003 and August 2012. Over this period, 5.34% of patients died (62), 37.61% were LTFU (437), and overall attrition was 42.94% (499). This resulted in overall incidence of death of 18 per 1000 person-years, of LTFU of 126 per 1000 person-years, and of attrition of 144 per 1000 person-years. The single factor significantly associated with overall attrition among the 1162 patients was absence of ART (HR: 0.11, 95% CI: 0.09,0.14). Both baseline BMI z-score (HR: 0.96, 95% CI: 0.91, 1.00) and receipt of ART (HR: 0.12, 95% CI: 0.10, 0.15) were significantly negatively associated with LTFU among all 1162 patients in this cohort. Conclusion: Not receiving ART was the single factor significantly associated with overall attrition. Both baseline BMI z-scores and receipt of ART were protective against LTFU among HIV positive children and adolescents enrolled in the Tukula Fenna project. Orphans need more nutritional support and improved access to early ART initiation.
Highlights
The availabilty and rapid scaling up of Antiretroviral Therapy (ART) programmes for infants and children with Human Immunodeficiency Virus (HIV) infection in Low-Middle Income Countries (LMIC) has enabled many to survive and grow into adolescents and adults [13]
Throughout the entire study period, 5.34% (62) of patients died, 37.61% were loss to follow-up (LTFU) (437), and overall attrition was 42.94% (499). This resulted in overall incidence of death of 18 per 1000 person-years, of LTFU of 126 per 1000 person-years, and of attrition of 144 per 1000 person-years
Not receiving ART was the single factor significantly associated with overall attrition among the 1162 patients studied, while both baseline BMI z-score and receipt of ART were significantly negatively associated with LTFU among all patients in this cohort
Summary
The availabilty and rapid scaling up of Antiretroviral Therapy (ART) programmes for infants and children with Human Immunodeficiency Virus (HIV) infection in Low-Middle Income Countries (LMIC) has enabled many to survive and grow into adolescents and adults [13]. Retention in care of children and adolescents with HIV remains a major operational challenge requiring innovation and creativity [4,5,6]. A number of studies have documented improved retention in care as well as better clinical outcomes using community-based or Community Home-Base Care (CHBC) models in Malawi, Haiti and elsewhere [10,11,12,13,14]. Home delivery of HIV counselling and testing, defaulter tracking, adherence counselling and monitoring in the home have been shown to be associated with improved retention in care [8,17]. We examine attrition and loss to follow-up (LTFU) and their baseline predictors among HIV-infected children and adolescents in a Community Home-Based Care (CHBC) model in Kampala (Uganda)
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