Abstract
BackgroundIn resource-limited settings, many HIV-infected patients are lost to follow-up (LTF) before starting ART; risk factors among those not eligible for ART at enrollment into care are not well described.MethodsWe examined data from 4,278 adults (3,613 women, 665 men) enrolled in HIV care through March 2007 in the MTCT-Plus Initiative with a CD4 count ≥200 cells/mm3 and WHO stage ≤ 2 at enrollment. Patients were considered LTF if > 12 months elapsed since their last clinic visit. Gender-specific Cox regression models were used to assess LTF risk factors.ResultsThe proportion LTF was 8.2 % at 12 months following enrollment, and was higher among women (8.4 %) than men (7.1 %). Among women, a higher risk of LTF was associated with younger age (adjusted hazard ratio [AHR]15–19/30+: 2.8, 95 % CI:2.1-3.6; AHR20–24/30+:1.9, 95 % CI:1.7-2.2), higher baseline CD4 count (AHR350–499/200–349:1.5; 95 % CI:1.0-2.1; AHR500+/200–349:1.5; 95 % CI:1.0-2.0), and being pregnant at the last clinic visit (AHR:1.9, 95 % CI:1.4-2.5). Factors associated with a lower risk of LTF included, employment outside the home (AHR:0.73, 95 % CI:0.59-0.90), co-enrollment of a family/household member (AHR:0.40, 95 % CI:0.26-0.61), and living in a household with ≥4 people (AHR:0.74, 95 % CI:0.64-0.85). Among men, younger age (AHR15–19/30+: 2.1, 95 % CI:1.2-3.5 and AHR30–34/35+:1.5, 95 % CI:1.0-2.4) had a higher risk of LTF. Electricity in the home (AHR:0.61, 95 % CI:0.41-0.91) and living in a household with ≥4 people (AHR:0.58, 95 % CI:0.39-0.85) had a lower risk of LTF.ConclusionsSocio-economic status and social support may be important determinants of retention in patients not yet eligible for ART. Among women of child-bearing age, strategies around sustaining HIV care during and after pregnancy require attention.
Highlights
In resource-limited settings, many HIV-infected patients are lost to follow-up (LTF) before starting anti-retroviral therapy (ART); risk factors among those not eligible for ART at enrollment into care are not well described
Factors associated with a lower risk of LTF included, employment outside the home (AHR:0.73, 95 % CI:0.59-0.90), co-enrollment of a family/household member (AHR:0.40, 95 % CI:0.26-0.61), and living in a household with ≥4 people (AHR:0.74, 95 % CI:0.64-0.85)
A review of studies from Sub Saharan Africa found that only 70-77 % of patients on ART are retained at the end of two years [2]
Summary
In resource-limited settings, many HIV-infected patients are lost to follow-up (LTF) before starting ART; risk factors among those not eligible for ART at enrollment into care are not well described. A large proportion of patients enrolling in HIV care are in the early stages of HIV infection and not yet eligible for anti-retroviral therapy (ART) [4]. Among patients who are eligible for ART but have not yet initiated treatment, studies suggest high rates of nonretention, with substantial death [6, 7] and LTF [7,8,9]. While an understanding of risk factors that may impact patient retention in this critical stage in the HIV care cascade is growing, further examination of lost to follow- up and its risk factors among patients not yet eligible for ART is warranted
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