JAIDS Journal of Acquired Immune Deficiency Syndromes. 53(3):405-411, MAR 2010

DOI: 10.1097/QAI.0b013e3181b843f0

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PMID: 19745753

Issn Print: 1525-4135

Publication Date: 2010/03/01


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Understanding Reasons for and Outcomes of Patients Lost to Follow-Up in Antiretroviral Therapy Programs in Africa Through a Sampling-Based Approach

Elvin Geng;David Bangsberg;Nicolas Musinguzi;Nneka Emenyonu;Mwebesa Bwana;Constantin Yiannoutsos;David Glidden;Steven Deeks;Jeffrey Martin;

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Abstract

Objectives:Losses to follow-up after initiation of antiretroviral therapy (ART) are common in Africa and are a considerable obstacle to understanding the effectiveness of nascent treatment programs. We sought to characterize, through a sampling-based approach, reasons for and outcomes of patients who become lost to follow-up.Design:Cohort study.Methods:We searched for and interviewed a representative sample of lost patients or close informants in the community to determine reasons for and outcomes among lost patients.Results:Three thousand six hundred twenty-eight HIV-infected adults initiated ART between January 1, 2004 and September 30, 2007 in Mbarara, Uganda. Eight hundred twenty-nine became lost to follow-up (cumulative incidence at 1, 2, and 3 years of 16%, 30%, and 39%). We sought a representative sample of 128 lost patients in the community and ascertained vital status in 111 (87%). Top reasons for loss included lack of transportation or money and work/child care responsibilities. Among the 111 lost patients who had their vital status ascertained through tracking, 32 deaths occurred (cumulative 1-year incidence 36%); mortality was highest shortly after the last clinic visit. Lower pre-ART CD4+ T-cell count, older age, low blood pressure, and a central nervous system syndrome at the last clinic visit predicted deaths. Of patients directly interviewed, 83% were in care at another clinic and 71% were still using ART.Conclusions:Sociostructural factors are the primary reasons for loss to follow-up. Outcomes among the lost are heterogeneous: both deaths and transfers to other clinics were common. Tracking a sample of lost patients is an efficient means for programs to understand site-specific reasons for and outcomes among patients lost to follow-up.

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