Disclosure of HIV status and its impact on the loss in the follow-up of HIV-infected patients on potent anti-retroviral therapy programs in a (post-) conflict setting: A retrospective cohort study from Goma, Democratic Republic of Congo.

Pierre Zalagile Akilimali,Patou Masika Musumari,Thorkild Tylleskar,Espérance Kashala-Abotnes,Patrick Kalambayi Kayembe,Paulin Beya Mutombo,François B Lepira,Mapatano Mala Ali,Eric Brian Faragher

doi:10.1371/journal.pone.0171407

Pierre Zalagile Akilimali, Patou Masika Musumari + Show 7 more

Open Access

https://doi.org/10.1371/journal.pone.0171407

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Abstract

BackgroundThe study aimed to identify the impact of non-disclosure of HIV status on the loss to follow-up (LTFU) of patients receiving anti-retroviral therapy.MethodologyA historic cohort of HIV patients from 2 major hospitals in Goma, Democratic Republic of Congo was followed from 2004 to 2012. LTFU was defined as not taking an ART refill for a period of 3 months or longer since the last attendance, and had not yet been classified as ‘dead’ or ‘transferred-out’. Kaplan-Meier plots were used to determine the probability of LTFU as a function of time as inclusive of the cohort. The log-rank test was used to compare survival curves based on determinants. Cox proportional hazard modeling was used to measure predictors of LTFU from the time of treatment induction until December 15th, 2012 (the end-point).ResultsThe median follow-up time was 3.99 years (IQR = 2.33 to 5.59). Seventy percent of patients had shared their HIV status with others (95% CI: 66.3–73.1). The proportion of LTFU was 12% (95%CI: 9.6–14.4). Patients who did not share their HIV status (Adjusted HR 2.28, 95% CI 1.46–2.29), patients who did not live in the city of Goma (Adjusted HR 1.97, 95% CI 1.02–3.77), and those who attained secondary or higher education level (Adjusted HR 1.60, 95% CI 1.02–2.53) had a higher hazard of being LTFU.ConclusionThis study shows the relationship between the non–disclosure HIV status and LTFU. Healthcare workers in similar settings should pay more attention to clients who have not disclosed their HIV status, and to those living far from health settings where they receive medication.

Highlights

Remarkable progress on HIV treatment has been made over the past few decades, HIV infection remains one of the greatest challenges facing the global health community
Patients who did not share their HIV status (Adjusted HR 2.28, 95% confidence intervals (CI) 1.46–2.29), patients who did not live in the city of Goma (Adjusted HR 1.97, 95% CI 1.02–3.77), and those who attained secondary or higher education level (Adjusted HR 1.60, 95% CI 1.02–2.53) had a higher hazard of being loss to followup (LTFU)
This study shows the relationship between the non–disclosure HIV status and LTFU

Summary

Introduction

Remarkable progress on HIV treatment has been made over the past few decades, HIV infection remains one of the greatest challenges facing the global health community. Access to anti-retroviral therapy (ART) has markedly increased, especially in Sub-Saharan Africa. In addition to the challenge of increasing access to ART, lost to follow-up (LTFU) as a result of the failure of retention of HIV-infected individuals in treatment programs has been challenging in Sub-Saharan Africa. A range of factors associated with LTFU have been documented, which include—but are not limited to—lack of social support, non-disclosure of HIV status, lower CD4+ cell baseline at initiation of treatment, advanced HIV clinical stage (III, IV), regimen type, food insecurity, and drug stock-out [2,3,4]. The study aimed to identify the impact of non-disclosure of HIV status on the loss to followup (LTFU) of patients receiving anti-retroviral therapy

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Conclusion