Abstract
BackgroundLoss to follow-up (LTFU) is viewed as a major challenge in improving retention in HIV treatment. In Vietnam, the reasons for disengagement from clinics and the effect of injection drug use (IDU) on LTFU with unknown outcome (true LTFU) are not well known.MethodsPatients receiving antiretroviral therapy (ART) from two HIV clinics in Hanoi were included in this observational study between 2007 and 2012, and followed up every 6 months until the end of 2013. The reasons for disengagement from the clinic, and ART status during imprisonment were investigated in patients with a history of IDU to identify true LTFU. The retention rate at 6–54 months and true LTFU rate were calculated. Cox proportional hazards regression models were performed to identify factors associated with true LTFU.ResultsThere were 1,431 patients, with a follow-up time of 4,371 person-years (median 2.49 years). At the end of the follow-up period, 71 (5.0%) patients died, 79 (5.5%) transferred to other clinics, 16 (1.1%) disengaged from the clinics, and the calculated true LTFU was 45 (3.1%), with 12-month ART retention rate of 95.3% for the entire study population. Imprisonment was the most frequent reason for disengagement from the clinics. True LTFU correlated significantly with low CD4 count and high plasma viral load, but not history of IDU.ConclusionImprisonment is a major cause of disengagement from HIV care among patients with a history of IDU.
Highlights
Evaluation of loss to follow-up (LTFU) has a considerable impact on estimation of retention in antiretroviral therapy (ART) [1,2,3]
Imprisonment is a major cause of disengagement from HIV care among patients with a history of injection drug use (IDU)
We retrospectively reviewed observational cohort data of adult HIV-infected patients (>17 years of age) on ART at the HIV Outpatient Clinics of the Bach Mai Hospital (BMH) and the National Hospital of Tropical Diseases (NHTD)
Summary
Evaluation of loss to follow-up (LTFU) has a considerable impact on estimation of retention in antiretroviral therapy (ART) [1,2,3]. In Vietnam, previous studies reported that as many as 5–15% of the patients who started ART were lost to follow-up [4,5,6], the definitions used for LTFU and duration of follow-up varied. The importance of history of injection drug use (IDU) was highlighted as a strong predictor for LTFU in these studies since IDU is the major route of HIV transmission in Vietnam [4,6]. No studies have examined the reasons for disengagement from the clinics and whether the patients discontinued ART at LTFU. In Vietnam, the reasons for disengagement from clinics and the effect of injection drug use (IDU) on LTFU with unknown outcome (true LTFU) are not well known
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