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

Abstract

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.

Pérdida de seguimiento y factores asociados en pacientes inscritos en el programa de HIV/sida del Hospital Universitario San Ignacio, Colombia, 2012-2013

“…En otros estudios se ha reportado que la falta de seguridad social es un factor asociado a la pérdida de seguimiento (29,30 Nota: los valores en negrilla son estadísticamente significativos local es la pérdida del cubrimiento de los planes de aseguramiento en salud o los cambios que se presentan en dichos planes (paso del régimen contributivo al subsidiado); el factor más relevante reportado como razón para el abandono de los programas de atención es el paso del empleo formal a la condición de cesante.…”

Pretreatment Loss-to-Follow-Up after HIV Diagnosis from 27 Counseling and Testing Centers across India

“…In all, 777 participants were interviewed at referral ARTCs within 60 days of their posttest counseling after a median of 7 days (interquartile range, [3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18]; this included 9 of the 12 HIV-positive pregnant women. More than half (59.8%) of the participants registered at the ARTC within 7 days of collecting the test result, 29.9% by 30 days, and 10.3% after 30 days.…”

The Perspective of HIV Providers in Western Kenya on Provider-Patient Relationships

“…ART coverage in Kenya increased from 64% in 2008 to 80% in 2013 (NACC, 2014). Despite this achievement, poor adherence and high loss to follow-up (LTFU) rates along the cascade of HIV care (Hassan et al, 2012; Karcher, Omondi, Odera, Kunz, & Harms, 2007; Mann et al, 2013; Mûnene & Ekman, 2015; Ochieng-Ooko et al, 2010) reduce the effectiveness of these efforts. These challenges have been attributed to various individual, social, and structural factors (Fox & Rosen, 2010; Merten et al, 2010; Ochieng-Ooko et al, 2010; Posse, Meheus, Van Asten, Van Der Ven, & Baltussen, 2008; Reda & Biadgilign, 2012; Vreeman et al, 2009).…”