Starting antiretroviral therapy within seven days of a positive HIV test increased the risk of loss to follow up in a primary healthcare clinic: a retrospective cohort study in Masaka, Uganda

Abstract

19Background: Retention of patients initiated on antiretroviral therapy (ART) and good adherence 20 remain cornerstones to long-term viral suppression. In this era of test and treat (T&T), ensuring that 21 patients initiated on ART remain connected to HIV clinics will be key to the achievement of the 22 UNAIDS 90-90-90 targets. Currently, limited studies have evaluated the effect instant ART initiation 23 has on loss to follow up in a typical service healthcare setting. We studied the cumulative incidence, 24 incidence rate of loss to follow up (LTFU), and factors associated with loss to follow up (LTFU) in a 25 primary healthcare clinic that has practiced test and treat since 2012. 26Methods: We retrospectively drew routine program data of patients initiated on ART from January 27 2012 to December 2016. We defined LTFU as failure of a patient to return to the HIV clinic for at 28 least 90 days from the date of their last appointment. We calculated cumulative incidence, incidence 29 rate and fitted a multivariable Cox proportion hazards regression model to determine factors associated 30 with LTFU. 31Results: Of the 8,136 patients included in our sample, 3,606 (44.3%) started ART within seven days 32 of HIV diagnosis. Females were 62.3%, median (interquartile range) age at start of ART was 30 (25, 33 37) years, 50.1% had access to a mobile phone, 54.0% had a baseline CD4 cell count of <350 cells/ml, 34 14.8% were in either WHO stage 3 or 4 at baseline and 75.9% had a normal body mass index (BMI). 35There were 1,207 cases of LTFU observed over 15953.0 person years at risk. The overall incidence 36 rate (IR) of LTFU was 7.6 (95% CI=7.2-8.0) per 100 person years of observation (pyo). Cumulative 37 incidence of LTFU increased with duration of follow up from 8.8% (95% CI=8.2-9.4%) and 12.0% 38 (95% CI=11.2-12.7%) at 6 and 12 months, to 17.9% (95% CI=16.9-18.9%) and 20.1% (95% CI=18.9-39 21.3%) at 36, and 48 months respectively. Predictors of elevated risk of LTFU were; starting ART 40 within 7 days of a positive diagnosis ((aHR) =1.39, 95% CI, 1.13-1.71), lack of access to a telephone 41 set (aHR=1.60, 95% CI, 1.29-1.99) and baseline WHO clinical stage 3 or 4 (aHR =1.53, 95% CI, 1.11-42 2.11). Factors associated with a reduced risk of LTFU were; baseline age ≥25years, and having a BMI 43 ≥ 30 (aHR =0.28, 95% CI, 0.15-0.51). 44 Conclusion: Initiation of ART within 7 days of an HIV diagnosis was associated with an elevated risk 45 of loss to follow up. Steep ART initiation needs to be backed by enhanced adherence and retention 46 counseling to reach the 2020 UNAIDS goals and beyond.47 Keywords: Loss to follow up, Test and Treat, antiretroviral therapy, Retention.48 49 Background and rationale 50 By the end of 2017, the World Health Organization (WHO) estimated that globally about 36.9 million 51 people were living with HIV (PLHIV) and 1.8 million new infections occurred that year; over two 52 thirds of the new infections were in Sub Saharan Africa (SSA) with about 50,000 in Uganda. During 53 the same time, about 21.7 mi...

Attrition rate and its predictors among adults receiving anti-retroviral therapy following the implementation of the “Universal Test and Treat strategy” at public health institutions in Northern Ethiopia. A retrospective follow-up study

“…These three “95-95-95” targets suggest that 95% of HIV-infected individuals should know their status, 95% of individuals who know their status should get access to anti-retro-viral therapy (ART), and 95% of individuals on ART should achieve viral suppression, respectively [ 3 ]. In this regard, access to ART has been rapidly expanded both nationally and globally, whereby nearly 28.2 million (74.8%) HIV-positive patients have been receiving it globally [ 1 , 4 ]. Additionally, ART has shown impressive results in lowering new HIV infection as well as HIV/AIDS-related morbidity and mortality.…”

“…Additionally, ART has shown impressive results in lowering new HIV infection as well as HIV/AIDS-related morbidity and mortality. According to the UNAIDS 2021 report, ART has shown a 32% and 52 % global reduction in the incidence of new HIV infection and HIV/AIDS-related mortality, respectively, since 2010 [ 4 ].…”