TY - JOUR
T1 - Determinants of loss to follow-up in patients on antiretroviral treatment, South Africa, 2004-2012
T2 - A cohort study
AU - Mberi, Mazvita Naome
AU - Kuonza, Lazarus Rugare
AU - Dube, Nomathemba Michelle
AU - Nattey, Cornelius
AU - Manda, Samuel
AU - Summers, Robert
N1 - Publisher Copyright:
© 2015 Mberi et al.
PY - 2015/7/4
Y1 - 2015/7/4
N2 - Background: The number of Human Immunodeficiency Virus (HIV) infected people eligible for initiation on antiretroviral Therapy (ART) is increasing. ART programmatic success requires that patients who are taking ART remain on treatment and are followed up regularly. This study investigated factors associated with being lost to follow-up, in a cohort of patients enrolled in a pharmacovigilance study in South Africa. Methods: This was a retrospective observational cohort study performed at one of the Medunsa National Pharmacovigilance Centre's (MNPC) ART sentinel surveillance sites. Loss to Follow-up (LTFU) was defined as "a patient who had been followed up at the sentinel site, who had not had contact with the health facility for 180 days or more since their last recorded expected date of return or if there were 180 days or more between the expected date of return and the next clinic visit". Results: Out of 595 patients, 65.5 % (n∈=∈390) were female and 23.4 % (n∈=∈139) were LTFU. The median time on ART before LTFU was 21.5 months (interquartile range: 12.9 - 34.7 months). The incidence rate of LTFU was 103 per 1000 person-years in the first year on ART and increased to 405 per 1000 person-years in the eighth year of taking ART. Factors associated with becoming LTFU included not having a committed partner (Adjusted Hazard Ratio (aHR): 2.9, 95 % Confidence Interval (CI):1.19-6.97, p∈=∈0.019), being self-employed (aHR: 13.9, 95 % CI:2.81∈-∈69.06, p∈=∈0.001), baseline CD4 count∈>∈200 cells/ml (aHR: 3.8, 95 % CI: 1.85-7.85, p∈<∈0.001), detectable last known Viral Load (VL) (aHR: 3.6, 95 % CI:1.98∈-∈6.52, p∈<∈0.001) and a last known World Health Organisation clinical stage three or four (aHR: 2.0, 95 % CI:1.22-3.27, p∈=∈0.006). Patients that previously had an ART adverse event had a lower risk (aHR: 0.6, 95 % CI: 0.38∈-∈0.99, p∈=∈0.044) of becoming LTFU than those that had not. Conclusion: The incidence rate of LTFU increases with additional years on ART. Intensified measures to improve patient retention on ART must be prioritised with increasing patient time on ART and in patients that are at increased risk of becoming lost to follow-up.
AB - Background: The number of Human Immunodeficiency Virus (HIV) infected people eligible for initiation on antiretroviral Therapy (ART) is increasing. ART programmatic success requires that patients who are taking ART remain on treatment and are followed up regularly. This study investigated factors associated with being lost to follow-up, in a cohort of patients enrolled in a pharmacovigilance study in South Africa. Methods: This was a retrospective observational cohort study performed at one of the Medunsa National Pharmacovigilance Centre's (MNPC) ART sentinel surveillance sites. Loss to Follow-up (LTFU) was defined as "a patient who had been followed up at the sentinel site, who had not had contact with the health facility for 180 days or more since their last recorded expected date of return or if there were 180 days or more between the expected date of return and the next clinic visit". Results: Out of 595 patients, 65.5 % (n∈=∈390) were female and 23.4 % (n∈=∈139) were LTFU. The median time on ART before LTFU was 21.5 months (interquartile range: 12.9 - 34.7 months). The incidence rate of LTFU was 103 per 1000 person-years in the first year on ART and increased to 405 per 1000 person-years in the eighth year of taking ART. Factors associated with becoming LTFU included not having a committed partner (Adjusted Hazard Ratio (aHR): 2.9, 95 % Confidence Interval (CI):1.19-6.97, p∈=∈0.019), being self-employed (aHR: 13.9, 95 % CI:2.81∈-∈69.06, p∈=∈0.001), baseline CD4 count∈>∈200 cells/ml (aHR: 3.8, 95 % CI: 1.85-7.85, p∈<∈0.001), detectable last known Viral Load (VL) (aHR: 3.6, 95 % CI:1.98∈-∈6.52, p∈<∈0.001) and a last known World Health Organisation clinical stage three or four (aHR: 2.0, 95 % CI:1.22-3.27, p∈=∈0.006). Patients that previously had an ART adverse event had a lower risk (aHR: 0.6, 95 % CI: 0.38∈-∈0.99, p∈=∈0.044) of becoming LTFU than those that had not. Conclusion: The incidence rate of LTFU increases with additional years on ART. Intensified measures to improve patient retention on ART must be prioritised with increasing patient time on ART and in patients that are at increased risk of becoming lost to follow-up.
KW - Antiretroviral therapy
KW - Loss to follow-up
KW - Medunsa National Pharmacovigilance Centre
KW - Surveillance cohort
UR - http://www.scopus.com/inward/record.url?scp=84938982720&partnerID=8YFLogxK
U2 - 10.1186/s12913-015-0912-2
DO - 10.1186/s12913-015-0912-2
M3 - Review article
C2 - 26141729
AN - SCOPUS:84938982720
SN - 1472-6963
VL - 15
JO - BMC Health Services Research
JF - BMC Health Services Research
IS - 1
M1 - 259
ER -