Predictors Of Loss To Follow-up Research Articles

Predictors of loss to follow-up from HIV antiretroviral therapy in Namibia.

Despite progress on population-level HIV viral suppression, unknown outcomes amongst people who have initiated antiretroviral therapy (ART) in low- and middle-income countries, commonly referred to as loss to follow-up (LTFU), remains a barrier. The mean global estimate of LTFU is 20%, exceeding the World Health Organization target of <15%. Pervasive predictors associated with LTFU include younger age, low body mass index, low CD4 count, advanced HIV clinical stage and certain ART regimens. In Namibia, ART use by eligible individuals exceeds 85%, surpassing the global average. Nonetheless, LTFU remains a barrier to achieving viral suppression and requires research to elucidate context-specific factors. An observational cohort study was conducted in Namibia in 2012 by administering surveys to individuals who presented for HIV care and initiated ART for the first time. Additional data were collected from routine medical data monitoring systems. Participants classified as LTFU at 12 months were traced to confirm their status. Predictors of LTFU were analyzed using multivariable logistic regression. Of those who presented consecutively to initiate ART, 524 were identified as eligible to enroll in the study, 497 enrolled, and 474 completed the baseline questionnaire. The cohort had mean age 36 years, 39% were male, mean CD4 cell count 222 cells/mm3, 17% were WHO HIV clinical stage III-IV, and 14% started efavirenz-based regimens. Tracing participants classified as LTFU yielded a re-categorization from 27.8% (n = 132) to 14.3% (n = 68) LTFU. In the final multivariable model, factors associated with confirmed LTFU status were: younger age (OR 0.97, 95% CI 1.00–1.06, p = 0.02); male sex (OR 2.34, CI 1.34–4.06, p = 0.003); difficulty leaving work or home to attend clinic (OR 2.55, CI 1.40–4.65, p = 0.002); and baseline efavirenz-based regimen (OR 2.35, CI 1.22–4.51, p = 0.01). Interventions to reduce LTFU should therefore target young men, particularly those who report difficulty leaving work or home to attend clinic and are on an efavirenz-based regimen.

Loss to Follow-Up and Health Care Utilization After Initial Diagnosis of Eosinophilic Esophagitis.

Eosinophilic esophagitis (EoE) is a chronic disease, but the extent of patient loss to follow-up (LTFU) and health care utilization has not been fully investigated. To determine frequency and predictors of LTFU and health care utilization in EoE patients. In this retrospective cohort study, we extracted data from patients with a new diagnosis of EoE. Follow-up time for each patient was calculated as the time from the first diagnostic endoscopy to the last GI-related contact date in the medical record. Patients with and without LTFU were compared, and the volume of EoE-related health care interactions was recorded. Of 944 EoE cases, 249 (26%) met the definition for LTFU. Major reasons for LTFU were never being scheduled (45%) and inability to contact patients (40%). Factors independently associated with regular follow-up were having insurance (aOR 2.89; 95% CI 1.85-4.50), white race (aOR 2.16; 95% CI 1.37-3.41), and longer symptom length (aOR 1.04 per year; 95% CI 1.01-1.08). At the time of last contact, patients with follow-up had better symptom response (55% vs. 12%; p < 0.001), improved esophageal caliber (14.3 vs. 12.4mm; p = 0.005), and more histologic response (45% vs. 4% at 15 eos/hpf; p < 0.001). Health care utilization was high, with an average of 4.6 endoscopies and 4.0 clinic visits over the follow-up period. LTFU of newly diagnosed EoE cases was common and associated with lack of insurance, non-white race, and shorter symptom duration. Those who followed up had high health care utilization but improved response rates. Strategies are needed to help decrease LTFU in EoE.

Predictors of Loss to Follow-up in Patients on Antiretroviral Treatment in Centre Hospitalier Essos, Cameroon

Abstract Background: HIV remains one of the major public health issues in Cameroon. Progress has been made in attaining the 90-90-90 according to the UNAIDS target, the Loss to follow-up (LTFU) remains a significant challenge to attain the second and third 90. There is a gap of information concerning assessing predictors and determinants of LTFU in the Cameroonian setting taking into consideration psychosocial, economic, cultural, financial, and treatment-related factors. This study seeks to assess and evaluate the determinants and predictors of LTFU among patients enrolled for treatment in the Centre Hospitalier Essos (CHE), Cameroon. Methods: We carried out a retrospective case-control study among 200 patients from which, 100 cases of patients LTFU and 100 controls of regular patients from the treatment centre. Simple random sampling was used to select 100 participants from the case list and matched with 100 participants from the control list. We compared several demographic, social, disease-related, and treatment-related characteristics of the two groups to determine which properties are significantly associated with LTFU. Data analysis was done using the SPSS software. Bivariate and multivariate analysis was done with p value < 0.05, odds ratio 95% CI. Results: Out of 200 participants, the mean age was 38 ± 9years. A total of 74 (37%) participants' HIV status was known by a family member. About 50% (54) of those who were married had an HIV-positive partner and of these, 86% (46) were on treatment. On multivariate analysis, distance to health facility; occurrence of opportunistic infections; patient receiving treatment for other conditions; duration of psychological follow-up and number of adherence counselling sessions were found to be independently associated with loss to follow-up. Conclusion: With LTFU, there is a consequent increased risk of HIV transmission and also increased morbidity and mortality. Reinforcement of adherence counseling sessions, intensification of patient tracking especially for patients with comorbidities, transfer of patients in suburbs to health facilities closer to their areas of residence will be important to curb LTFU rates and improve on retention of patients LTFU.

Driving distances and loss to follow-up after hematopoietic cell transplantation.

In a recent multicenter analysis, long geographic distances predicted loss to follow‐up (LTF) among allogeneic hematopoietic cell transplantation (HCT) survivors. We hypothesized that lower frequencies of patient interactions (including in‐person appointments and telemedicine encounters) would predict LTF rather than long driving distances. However, in our retrospective single‐center analysis of 263 HCT survivors, the only predictors of LTF were residence in the furthest driving‐distance quartile and Medicaid insurance (but not annualized frequencies of patient interactions). Our findings suggest that telemedicine may not necessarily "rescue" long‐distance HCT survivors from LTF. Other solutions, for example patient‐specific partnerships with local providers, may be helpful.

Group Antenatal Care for Improving Retention of Adolescent and Young Pregnant Women Living With HIV in Kenya

Background: Pregnant and breastfeeding adolescents and young women living with HIV (AYWLH) have lower retention in prevention of mother-to-child transmission (PMTCT) services compared to older women. Methods: We evaluated a differentiated service model for pregnant and breast feeding AYWLH at seven health facilities in western Kenya. All pregnant AYWLH <25 years presenting for antenatal care (ANC) were invited to participate in group ANC visits including health education, self-care (measuring own weight and blood pressure), and peer-led support sessions conducted by health facility nurses per national guidelines. Antiretroviral treatment (ART) register data were used to assess loss to follow-up (LTFU) among newly-enrolled pregnant adolescent (<20 years) and young women (20-24 years) living with HIV starting ART in the pre- period (January-December 2016) and post-period (during implementation; December 2017-January 2019). Poisson regression models compared LTFU incidence rate ratios (IRR) in the first six months after PMTCT enrollment and risk ratios compared uptake of six week testing for HIV-exposed infants (HEI) between the pre- and post-periods (models adjusted for known predictors of LTFU and were examined separately by age group). Results: In the pre-period, 223 (63·2%) of 353 pregnant AYWLH <25 years newly enrolled in ANC had ART information, while 320 (71·1%) of 450 in the post-period had ART data (p=0·02). A higher proportion of women in the post-period (62·8%) had known HIV-positive status at first ANC visit compared to 49·3% in the pre-period (p<0·001). Among pregnant AYWLH <20 years, the incidence rate of LTFU in the first six months after enrollment in ANC services declined from 2·36 per 100 person months (95%CI 1·06-5·25) (14·2% lost by 6 months) in the pre-period to 1·41 per 100 person months (95%CI 0·53-3·77) (6·8% by six months) in the post-period. In both univariable and multivariable analysis, AYWLH <20 years in the post-period were almost 40% less likely to be LTFU compared to the pre-period, although this finding did not meet the threshold for statistical significance (adjusted incidence rate ratio 0·62, 95%CI 0·38-1·01, p=0·057). Testing for HEI was 10% higher overall in the post-period (adjusted risk ratio 1·10, 95%CI 1·01-1·21, p=0·04). Discussion: Interventions are urgently needed to improve outcomes among pregnant and postnatal AYWLH. We observed a trend towards increased retention among pregnant adolescents during our intervention and a statistically significant increase in uptake HEI testing at six weeks. Funding Statement: This project was supported by the U.S. President's Emergency Plan for AIDS Relief (PEPFAR) through the US Centers for Disease Control and Prevention (CDC) under the terms of Cooperative Agreement number U2GGH00994. Declaration of Interests: None of the authors have competing interests. Ethics Approval Statement: This study was reviewed and approved by the CDC Institutional Review Board (IRB) (protocol #7011·0). The study was also approved by the IRB at the Columbia University Irving Medical Center and the Kenya Medical Research Institute (KEMRI). A waiver of consent was granted for use of routinely collected retrospective data for the evaluation.

Nonoccupational post-exposure prophylaxis for HIV after sexual intercourse among women in Brazil: Risk profiles and predictors of loss to follow-up.

Access to antiretroviral-based HIV prevention has been marked by sex asymmetries, and its effectiveness has been compromised by low clinical follow-up rates. We investigated risk profiles of women who received nonoccupational post-exposure prophylaxis (nPEP), as well as the rates and predictive factors of loss to follow-up after nPEP initiation.Retrospective study evaluating 501 women who received nPEP between 2014 and 2015 at 5 HIV centers (testing centers-VCT, outpatient clinics, and infectious diseases hospital). Risk profiles were drawn based on the characteristics of the women and their sexual partners, and then stratified by sociodemographic indicators and previous use of HIV prevention services. Loss to follow-up (LTFU) was defined as not presenting for follow-up visits or for HIV testing after nPEP initiation. Predictors of LTFU were analyzed by calculating adjusted prevalence ratios (aPRs).Approximately 90% of women had sexual encounters that met the criteria established in the Brazilian guidelines for nPEP. Those who declared to be sex workers (26.5%) or drug users (19.2%) had the highest social vulnerability indicators. In contrast, women who had intercourse with casual partners of unknown HIV risk (42.7%) had higher education and less experience with previous HIV testing (89.3%) or nPEP use (98.6%). Of the women who received nPEP after sexual intercourse with stable partners, 75.8% had HIV-infected partners. LTFU rate was 72.8% and predictors included being Black (aPR = 1.15, 95% confidence interval [CI]: 1.03–1.30), using drugs/alcohol (aPR = 1.15, 95% CI: 1.01–1.32) and having received nPEP at an HIV outpatient clinic (aPR = 1.35, 95% CI: 1.20–1.51) or at an infectious diseases hospital (aPR = 1.37, 95% CI: 1.11–1.69) compared with a VCT. The risk of LTFU declined as age increased (aPR 41–59 years = 0.80, 95% CI: 0.68–0.96).Most women who used nPEP had higher socioeconomic status and were not part of populations most affected by HIV. In contrast, factors that contribute to loss to follow-up were: having increased social vulnerability; increased vulnerability to HIV infection; and seeking nPEP at HIV treatment services as opposed to at a VCT.

Status of HIV-infected patients classified as lost to follow up from a large antiretroviral program in southwest Nigeria.

BackgroundLoss to follow-up (LTFU) is a term used to classify patients no longer being seen in a clinical care program, including HIV treatment programs. It is unclear if these patients have transferred their care services elsewhere, died, or if there are other reasons for their LTFU. To better understand the status of patients meeting the criteria of LTFU, we traced a sample of HIV-infected patients that were LTFU from the Lagos University Teaching Hospital (LUTH) antiretroviral program.MethodsWe conducted a cross-sectional study of HIV-infected adult patients who enrolled for care between 2010 and 2014 at LUTH and were considered LTFU. Patients with locator information were traced using phone calls. Face-to-face interviews were used to collect data from successfully traced and consenting participants. Predictors of LTFU from LUTH, disengagement from care and willingness to re-engage in care in LUTH were assessed.ResultsOf 6108 registered patients, 3397 (56%) were LTFU and being unmarried was a predictor of being LTFU from LUTH. Of 425 patients that were traced, 355 (84%) were alive and 70 (16%) were dead. Two hundred and sixty-eight patients consented to interviews; 96 (35.8%) of these had transferred to another clinic for care while 172 (64.2%) were disengaged from care. More than half (149/268; 55.6%) were not on antiretroviral therapy (ART). Some of the primary reasons for LTFU were; long distance to clinic (56%) and feeling healthy (6.7%). Predictor of disengagement from care within the interviewed cohort was not having started ART. The predictors of willingness to re-engage in care included, not having started ART, male sex and longer duration in HIV care prior to LTFU.ConclusionMost of the interviewed cohort that was LTFU were truly disengaged from care and not on ART. Interventions are required to address processes of re-engagement of patients that are LTFU.

Incidence and predictors of LTFU among adults with TB/HIV co-infection in two governmental hospitals, Mekelle, Ethiopia, 2009\u20132016: survival model approach

BackgroundLost to follow-up (LTFU) negatively affects the treatment success of Anti-Retroviral Therapy (ART) and thus, increases Tuberculosis-Human Immunodeficiency Virus (TB/HIV) related morbidity, mortality and hospitalization. However, the incidence and predictors of loss to follow up (LTFU) among adults with TB/HIV co-infection have not yet well-investigated in Ethiopia. Therefore, this study was aimed at investigating the incidence and predictors of LTFU in the study setting in particular.MethodsA facility based retrospective cohort study was employed among 305 (114 anemic and 191 normal) TB/HIV co-infected adults in two governmental hospitals (Mekelle Hospital and Ayder Comprehensive Specialized Hospital), Mekelle, Ethiopia from 2009 to 2016 and data were collected using checklist. Besides to descriptive statistics, a cox regression analysis was applied to identify statistically significant predictors of LTFU at 5% level of significance. Eventually, the Adjusted Hazard Ratio (AHR) and 95% Confidence Interval (CI) were estimated and interpreted for predictors of LTFU in the final cox model.ResultsGenerally, 45 of 305 (14.8%) of TB/HIV co-infected adults were LTFU with an incidence rate of 4.5 new LTFUs per 100 Person Years (PYs) and a median follow up time of 3.1 years (Interquartile Range (IQR): 0.8–5.3 Years). Hemoglobin level ≤ 11.0 g/dl (AHR = 2.660; 95%CI: 1.459–4.848), and any history of OI/s (AHR = 3.795; 95%CI: 1.165–12.364) were risk factors of LTFU. While, adverse drug events (AHR = 0.451; 95%CI: 0.216–0.941), TB treatment completion (AHR = 0.121; 95% CI: 0.057–0.254), and being on Isoniazid Preventive Therapy (IPT) (AHR = 0.085; 95%CI: 0.012–0.628) had protective effect against LTFU.ConclusionsOne in approximately seven TB/HIV co-infected adults had experienced of LTFU with an incidence rate 4.5 LTFUs per 100 PYs. The LTFU rate was higher among adults with low baseline hemoglobin level, no adverse drug events, presence of OI/s, failure to complete TB treatment, and being not on IPT. Therefore, it is advisable to treat anemia and active TB, and preventing the occurrence of OIs including TB using IPT to reduce the incidence of LTFU among TB/HIV co-infected adults.

Survival Status and Predictors of Loss to Follow-up Among Adult Patients with Tuberculosis on Follow-up and Care in Public Health Facilities of Sheka Zone, South-West Ethiopia: Facility-Based, Retrospective Cohort Study

Background: Treatment success rate and loss to follow-up (LTFU) in patient with tuberculosis (TB) are a great concern in Ethiopia. However, available information is inadequate to assess the magnitude of LTFU and its predictors in geographically remote regions of Ethiopia. Objectives: The current study aimed at assessing the survival status and predictors of LTFU among adult patients with tuberculosis registered in TB treatment and care center in public health institutions of Sheka Zone, South-West Ethiopia. Methods: A facility-based, retrospective cohort study was conducted from 01 to 30 August 2016. The LTFU was defined as patient with tuberculosis under follow-up being lost before treatment initiation or treatment interruption for two or more successive months. Kaplan-Meir curve and Cox proportional hazard model were fitted to determine survival time and predictors with survival status, respectively. Results: A total of 1319 patients with tuberculosis were followed up for a total of 7056.87 months from treatment initiation to outcomes. Of these, 117 (8.9%) patients were lost. The survival status at the completion of the intensive and continuation phases was 93.7% and 90%, respectively. Living farther than 10 Km away from the nearest health facility (adjusted odds ratio (AHR) = 4.9, 95% confidence interval (CI): 3.02 - 12.50) and not being adhered to anti-retroviral therapy (AHR = 5.3, 95%CI: 1.63 - 8.12) were significantly associated with LTFU. Conclusions: Significant TB patient LTFU was observed during the first two months of treatment and care. LTFU was high in patients not adhered to antiretroviral therapy (ART) and living far.

Retention of HIV infected pregnant and breastfeeding women on option B+ in Gomba District, Uganda: a retrospective cohort study

BackgroundLifelong antiretroviral therapy for HIV infected pregnant and lactating women (Option B+) has been rapidly scaled up but there are concerns about poor retention of women initiating treatment. However, facility-based data could underestimate retention in the absence of measures to account for self-transfers to other facilities. We assessed retention-in-care among women on Option B+ in Uganda, using facility data and follow-up to ascertain transfers to other facilities.MethodsIn a 25-month retrospective cohort analysis of routine program data, women who initiated Option B+ between March 2013 and March 2015 were tracked and interviewed quantitatively and qualitatively (in-depth interviews). Kaplan Meier survival analysis was used to estimate time to loss-to-follow-up (LTFU) while multivariable Cox proportional hazards regression was applied to estimate the adjusted predictors of LTFU, based on facility data. Thematic analysis was done for qualitative data, using MAXQDA 12. Quantitative data were analyzed with STATA® 13.ResultsA total of 518 records were reviewed. The mean (SD) age was 26.4 (5.5) years, 289 women (55.6%) attended primary school, and 53% (276/518) had not disclosed their HIV status to their partners. At 25 months post-ART initiation, 278 (53.7%) were LTFU based on routine facility data, with mean time to LTFU of 15.6 months. Retention was 60.2 per 1000 months of observation (pmo) (95% CI: 55.9–64.3) at 12, and 46.3/1000pmo (95% CI: 42.0–50.5) at 25 months. Overall, 237 (55%) women were successfully tracked and interviewed and 43/118 (36.4%) of those who were classified as LTFU at facility level had self-transferred to another facility. The true 25 months post-ART initiation retention after tracking was 71.3% (169/237). Women < 25 years, aHR = 1.71 (95% CI: 1.28–2.30); those with no education, aHR = 5.55 (95% CI: 3.11–9.92), and those who had not disclosed their status to their partners, aHR = 1.59 (95% CI: 1.16–2.19) were more likely to be LTFU. Facilitators for Option B+ retention based on qualitative findings were adequate counselling, disclosure, and the desire to stay alive and raise HIV-free children. Drug side effects, inadequate counselling, stigma, and unsupportive spouses, were barriers to retention in care.ConclusionsRetention under Option B+ is suboptimal and is under-estimated at health facility level. There is need to institute mechanisms for tracking of women across facilities. Retention could be enhanced through strategies to enhance disclosure to partners, targeting the uneducated, and those < 25 years.

High rates of retention and viral suppression in the scale-up of antiretroviral therapy adherence clubs in Cape Town, South Africa.

Introduction: Increasingly, there is a need for health authority scale up of successfully piloted differentiated models of antiretroviral therapy (ART) delivery. However, there is a paucity of evidence on system-wide outcomes after scale-up. In the Cape Town health district, stable adult patients were referred to adherence clubs (ACs) – a group model of ART delivery with five visits per year. By the end of March 2015, over 32,000 ART patients were in an AC. We describe patient outcomes of a representative sample of AC patients during this scale-up.Methods: Patients enrolled in an AC at non-research supported sites between 2011 and 2014 were eligible for analysis. We sampled 10% of ACs (n = 100) in quintets proportional to the number of ACs at each facility, linking each patient to city-wide laboratory and service access data to validate retention and virologic outcomes. We digitized registers and used competing risks regression and cross-sectional methods to estimate outcomes: mortality, transfers, loss to follow-up (LTFU) and viral load suppression (≤400 copies/mL). Predictors of LTFU and viral rebound were assessed using Cox proportional hazards models.Results: Of the 3216 adults contributing 4019 person years of follow-up (89% in an AC, median 1.1 years), 70% were women. Retention was 95.2% (95% CI, 94.0-96.4) at 12 months and 89.3% (95% CI, 87.1-91.4) at 24 months after AC enrolment. In the 13 months prior to analysis closure, 88.1% of patients had viral load assessments and of those, viral loads ≤400 copies/mL were found in 97.2% (95% CI, 96.5-97.8) of patients. Risk of LTFU was higher in younger patients and in patients accessing ART from facilities with larger ART cohorts. Risk of viral rebound was higher in younger patients, those that had been on ART for longer and patients that had never sent a buddy to collect their medication.Conclusions: This is the first analysis reporting patient outcomes after health authorities scaled-up a differentiated care model across a high burden district. The findings provide substantial reassurance that stable patients on long-term ART can safely be offered care options, which are more convenient to patients and less burdensome to services.

The Effect of Timing of Initiation of Antiretroviral Therapy on Loss to Follow-up in HIV–Tuberculosis Coinfected Patients in South Africa: An Open-Label, Randomized, Controlled Trial

To evaluate the effect of early integrated, late-integrated, and delayed antiretroviral therapy (ART) initiation during tuberculosis (TB) treatment on the incidence rates of loss to follow-up (LTFU) and to evaluate the effect of ART initiation on LTFU rates within trial arms in patients coinfected with TB and HIV. A substudy within a 3-armed, open label, randomized, controlled trial. Patients were randomized to initiate ART either early or late during TB treatment or after the TB treatment completion. We reported the incidence and predictors of LTFU from TB treatment initiation during the 24 months of follow-up. LTFU was defined as having missed 4 consecutive monthly visits with the inability to make contact. Of the 642 patients randomized, a total of 96 (15.0%) were LTFU at a median of 6.0 [interquartile range (IQR), 1.1-11.3] months after TB treatment initiation. Incidence rates of LTFU were 7.5 per 100 person-years (PY) [95% confidence interval (CI): 4.9 to 11], 10.9 per 100 PY (95% CI: 7.6 to 15.1), and 11.0 per 100 PY (95% CI: 7.6 to 15.4) in the early integrated, late-integrated, and delayed treatment arms (P = 0.313). Incidence rate of LTFU before and after ART initiation was 31.7 per 100 PY (95% CI: 11.6 to 69.0) vs. 6.1 per 100 PY (95% CI: 3.7 to 9.4); incidence rate ratio (IRR) was 5.2 (95% CI: 2.1 to 13.0; P < 0.001) in the early integrated arm; 31.9 per 100 PY (95% CI: 20.4 to 47.5) vs. 4.7 per 10 PY (95% CI: 2.4 to 8.2) and IRR was 6.8 (95% CI: 3.4 to 13.6; P < 0.0001) in the late-integrated arm; and 21.9 per 100 PY (95% CI: 14.6 to 31.5) vs. 2.8 per 100 PY (95% CI: 0.9 to 6.6) and IRR was 7.7 (95% CI: 3.0 to 19.9; P < 0.0001) in the sequential arm. LTFU rates were not significantly different between the 3 trials arms. However, ART initiation within each trial arm resulted in a significant reduction in LTFU rates among TB patients.

Early loss to follow‐up of recently diagnosed HIV‐infected adults from routine pre‐ART care in a rural district hospital in Kenya: a cohort study

ObjectiveTo determine the rate and predictors of early loss to follow-up (LTFU) for recently diagnosed HIV-infected, antiretroviral therapy (ART)-ineligible adults in rural Kenya.MethodsProspective cohort study. Clients registering for HIV care between July 2008 and August 2009 were followed up for 6 months. Baseline data were used to assess predictors of pre-ART LTFU (not returning for care within 2 months of a scheduled appointment), LTFU before the second visit and LTFU after the second visit. Logistic regression was used to determine factors associated with LTFU before the second visit, while Cox regression was used to assess predictors of time to LTFU and LTFU after the second visit.ResultsOf 530 eligible clients, 178 (33.6%) were LTFU from pre-ART care (11.1/100 person-months). Of these, 96 (53.9%) were LTFU before the second visit. Distance (>5 km vs. <1 km: adjusted hazard ratio 2.6 [1.9–3.7], P < 0.01) and marital status (married vs. single: 0.5 [0.3–0.6], P < 0.01) independently predicted pre-ART LTFU. Distance and marital status were independently associated with LTFU before the second visit, while distance, education status and seasonality showed weak evidence of predicting LTFU after the second visit. HIV disease severity did not predict pre-ART LTFU.ConclusionsA third of recently diagnosed HIV-infected, ART-ineligible clients were LTFU within 6 months of registration. Predictors of LTFU among ART-ineligible clients are different from those among clients on ART. These findings warrant consideration of an enhanced pre-ART care package aimed at improving retention and timely ART initiation.

Predictors identified for losses to follow-up among HIV-seropositive patients

Background and Objective This study aims to describe predictors of loss to follow-up (LFU) in the French Hospital Database on HIV infection (FHDH). Methods We studied the prevalence and predictors of LFU among 34,835 patients enrolled in FHDH in 1999. Impacts of demographic and clinical factors were studied by using multivariate logistic regression analysis. Results Among included patients, 1,478 (4.2%) died and 2,950 (8.5%) were lost to follow-up. LFU was more frequent among recently diagnosed patients (<1 year, 16.8%; > 1 year, 7.1). Among recently diagnosed patients, LFU was less frequent among men who have sex with men (MSM) [odds radio (OR) = 0.6, 95% confidence interval (CI) = (0.5;0.7)], and among patients with AIDS [OR = 0.5, 95%CI = (0.4;0.6)], and more frequent among immigrants [OR = 1.3, 95%CI = (1.0;1.5)]. Among less recently diagnosed patients, LFU was more frequent in French Departments of America than in the Paris area. The proportion of LFU fell with age, and LFU was more frequent among intravenous drug users (IVDU) than among MSM [OR = 1.2, 95%CI = (1.1;1.4)]. Patients with viral load >5,000 copies/mL or CD4 cell counts <200/mm 3 were more likely to be lost to follow-up. Conclusions Recently diagnosed patients, IVDU, and immigrants are more often lost to follow-up, and should therefore receive special attention.