Risk factors for loss to follow-up in human immunodeficiency virus care in the Greater Accra Regional Hospital in Ghana: a retrospective cohort study

Abstract

Background Loss of human immunodeficiency virus (HIV)-positive patients to follow-up increases HIV-related morbidity and mortality. This study identified the factors associated with loss to follow-up (LTFU) in an urban health facility in Ghana. Methods A 12-y retrospective study was conducted using routinely collected data from the National Acquired Immune Deficiency Syndrome (AIDS) Control Programme (NACP) on persons living with HIV/AIDS (PLWHA) who initiated antiretroviral therapy (ART) from 2006 to 2017 at the Greater Accra Regional Hospital. Convenience sampling was used to select the study area. All gathered data were exported to Stata 14 statistical software for analysis. Results A total of 4330 PLWHA initiated ART between January 2006 and December 2017. Of these, 1166 (26.9%) were lost to follow-up over the 12-y period. The factors associated with LTFU included being a Muslim (adjusted hazard ratio [aHR] 1.31 [95% confidence interval {CI} 1.05 to 1.65]), having CD4 <250 cells/ml (aHR 1.45 [95% CI 1.21 to 1.76]) and completing adherence counselling (aHR 1.58 [95% CI 1.31 to 1.92]). Having other sources of health care funding and disclosure of one’s disease status were found to be protective (aHR 0.74 [95% CI 0.58 to 0.94] and 0.80 [95% CI 0.65 to 0.98], respectively). Conclusions Some of the determinants of LTFU in the hospital are comparable to those found in other parts of Africa and could be addressed using existing interventions.

Loss to Follow Up and Missing Clinical Information, a Challenge of Hiv Management Care In A Developing Country; a 14-Year Retrospective Analysis

“…This higher prevalence was observed even though the LTFU criterium for the Lagos study was 180 days without care services as against 90 days in the present study. Another study done in Ghana from 2006 to 2017 reported a lower LTFU prevalence of 27% using the same LFTU criteria as the present study [17]. Furthermore, the present study, observed that there was an average incidence rate of 13 new cases of loss to follow-up per 100 HIV clients per year (100 person-years).…”

Undernutrition increased the risk of loss to follow-up among adults living with HIV on ART in Northwest Ethiopia: a retrospective cohort study

“…LTFU has been associated with various unfavourable treatment outcomes, such as frequent hospitalizations, high risk of treatment failure, high rate of mortality, and high risk of opportunistic infections (OIs) 9 . SSA based studies have shown that the most common risk factors of LTFU in adults living with HIV are poor ART adherence, being younger, being male, not disclosing HIV-status, advanced World Health Organization (WHO) clinical disease stage (III and IV), low CD4 cell count, not taking co-trimoxazole preventive therapy (CPT), not taking isoniazid preventive therapy (IPT), and being undernourished [10][11][12][13][14] .Various studies conducted in Africa have shown that undernutrition is significantly associated with a higher risk of LTFU in adults living with HIV receiving ART [14][15][16][17][18] . Undernutrition may indirectly increase the risk of…”