Journal
BMC HEALTH SERVICES RESEARCH
Volume 15, Issue -, Pages -Publisher
BIOMED CENTRAL LTD
DOI: 10.1186/s12913-015-0898-9
Keywords
HIV; AIDS; Anti-retroviral therapy; Pre-ART; Lost to follow up; Risk factors; Social support
Categories
Funding
- Cote d'Ivoire: Formation Sanitaire Urbaine de Yopougon-Attie, Abidjan
- Cameroon: Mbingo Baptist Hospital, Bamenda
- Kenya:Moi Hospital and Mosoriot Rural Health Center, Eldoret
- Kenya:Nyanza Provincial General Hospital, Kisumu
- Mozambique: Beira and Chimoio Day Hospitals
- Rwanda: Treatment and Research AIDS Center
- Rwanda: Kicukiro Health Center, Kigali
- South Africa: Ekuphileni Clinic, Durban
- South Africa: Cato Manor, Durban
- South Africa: Langa Clinic
- South Africa: City of Cape Town Health Department, Cape Town
- South Africa: Perinatal HIV Research Unit
- South Africa: Chris Hani Baragwanath Hospital, Soweto
- Thailand: Thai Red Cross Research Center, Bangkok
- Uganda: Mulago Hospital, Kampala
- Uganda: St. Francis Nsambya Hospital, Kampala
- Zambia: Chelstone and Mtendere District Health Clinics, Lusaka
- Cameroon: Banso Baptist Hospital, Bamenda
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Background: 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. Methods: We 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/mm(3) 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. Results: The 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; AHR(20-24/30+):1.9, 95 % CI:1.7-2.2), higher baseline CD4 count (AHR(350-499/200-349):1.5; 95 % CI:1.0-2.1; AHR(500+/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 (AHR(15-19/30+):2.1, 95 % CI:1.2-3.5 and AHR(30-34/35+):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. Conclusions: Socio-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.
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