Abstract:

Long-term regular follows up of ART clients is an important component of HIV care, treatment, and prevention. Clients who are lost to follow-up while on treatment compromise their own health leading to poor treatment outcomes, which has a negative impact on HIV control programs. This study aimed to determine the factors contributing to the lost to follow-up (LTFU) of HIV clients on ARVs at the ART clinic, Bor state hospital. A retrospective cohort study of 60 people living with HIV from 576 clients who are lost to follow-up and attending an ART clinic service between Jan. 2015 - Dec. 2019 was undertaken. LTFU was defined as not taking an ARVs drug refill for a period of three months or longer from the last attendance for refill and not yet classified as ‘died’ or ‘transferred out. A total of 1993 clients enrolled at the HIV ART clinic, a total of 576 clients (29.0%) were defined as LTFU from enrolled clients, and 1417 clients (71.0%) were actively being followed up and on ART in the HIV ART clinic. Overall, these data suggested that LTFU in this study was high in patients who were married, low level of education, stigma-related factors, unemployment among clients, and clinical stages I &II were associated with LTFU in this study.

References:

[1] atilda K, Esther B, Joy K, et al. Loss to Follow-Up among HIV Positive Pregnant and Lactating Mothers on Lifelong Anti-retroviral Therapy for PMTCT in Rural Uganda.

[2] Bryan E. Shepherd, Meridith B, Lara M. E. Vaz, et al. Impact of Definitions of Loss to Follow-up on Estimates of Retention, Disease Progression, and Mortality: Application to an HIV Program in Mozambique, American Journal of Epidemiology, Volume 178, Issue 5, 1 September 2013, Pages 819–828, https://doi.org/10.1093/aje/kwt030.

[3] Chi BH, Yiannoutsos CT, Westfall AO, et al. (2011) Universal Definition of Loss to Follow-Up in HIV Treatment Programs: A Statistical Analysis of 111 Facilities in Africa, Asia, and Latin America. PLoS Med 8(10): e1001111. https://doi.org/10.1371/journal.pmed.1001111.

[4] Opio, D., Semitala, F.C., Kakeeto, A. et al. Loss to follow-up and associated factors among adult people living with HIV at public health facilities in Wakiso district, Uganda: a retrospective cohort study. BMC Health Serv Res 19, 628 (2019). https://doi.org/10.1186/s12913-019-4474-6.

[5] Faraz A, Gideon M, Joseph S. et al. Identifying and Reengaging Patients Lost to Follow-Up in Rural Africa: The “Horizontal” Hospital-Based Approach in Uganda. Global Health: Science and Practice March 2019, 7(1):103-115; https://doi.org/10.9745/GHSP-D-18-00394.

[6] Williams H, Filbert F, Brouno P. et al. Lost to follow up and clinical outcomes of HIV adult patients on anti-retroviral therapy in care and treatment centers in Tanga City, north-eastern Tanzania. Tanzania Journal of Health Research Doi: http://dx.doi.org/10.4314/thrb.v14i4.3 Volume 14, Number 4, October 2012.

[7] MOH. Fact sheet on the Uganda Population HIV Impact Assessment [Internet]. WHO | Regional Office for Africa. 2017 [cited 2018 Aug 21]. Available from: https://www.afro.who.int/publications/fact-sheet-ugandapopulation-hiv-impact-assessment.

[8] Bior, Awak Deng. HIV/AIDS: A Threat to National Security in South Sudan. Sudd Institute, 2014, www.jstor.org/stable/resrep11027 Accessed 26 July 2020.

[9] Opio, D., Semitala, F.C., Kakeeto, A. et al. Loss to follow-up and associated factors among adult people living with HIV at public health facilities in Wakiso district, Uganda: a retrospective cohort study. BMC Health Serv Res 19, 628 (2019). https://doi.org/10.1186/s12913-019-4474-6.

[10] Kiwanuka J, Mukulu Waila J, Muhindo Kahungu M, et al. Determinants of loss to follow-up among HIV positive patients receiving anti-retroviral therapy in a test and treat setting: A retrospective cohort study in Masaka, Uganda. PLoS One. 2020; 15(4): e0217606. Published 2020 Apr 7. doi: 10.1371/journal.pone.0217606.

[11] Geng EH, Bangsberg DR, Musinguzi N, et al. Understanding reasons for and outcomes of patients lost to follow-up in anti-retroviral therapy programs in Africa through a sampling-based approach. J Acquir Immune Defic Syndr. 2010; 53(3):405-411. doi:10.1097/QAI.0b013e3181b843f0.

[12] Vervölgyi, E., Kromp, M., Skipka, G. et al. Reporting of loss to follow-up information in randomised controlled trials with time-to-event outcomes: a literature survey. BMC Med Res Methodol 11, 130 (2011). https://doi.org/10.1186/1471-2288-11-130.

[13] Frédérique C, Kathrin Z, Olivia K, et al. Outcomes of Patients Lost to Follow-up in African Antiretroviral Therapy Programs: Individual Patient Data Meta-analysis, Clinical Infectious Diseases, Volume 67, Issue 11, 1 December 2018, Pages 1643–1652, https://doi.org/10.1093/cid/ciy347.

[14] Zürcher K, Mooser A, Anderegg N, et al. Outcomes of HIV-positive patients lost to follow-up in African treatment programmes. Trop Med Int Health. 2017; 22(4):375-387. doi:10.1111/tmi.12843In.

[15] Kaplan S, Nteso KS, and Ford N, et al. Loss to follow-up from anti-retroviral therapy clinics: A systematic review and meta-analysis of published studies in South Africa from 2011 to 2015. South Afr J HIV Med. 2019; 20(1):984. Published 2019 Dec 18. doi:10.4102/sajhivmed. v20i1.984in 16 –.

[16] Goggin K, Hurley EA, Staggs VS, et al. Rates and Predictors of HIV-Exposed Infants Lost to Follow-Up during Early Infant Diagnosis Services in Kenya. AIDS Patient Care STDS, 33(8):346-353, 01 Aug 2019.

[17] World Health Organisation (2008), Mortality of Patients Lost to follow-up in Antiretroviral Treatment Programs in Resource limited setting. System review and Meta-Analysis. Available at (www.plosone.org/./info:doi/2F10.137).

[18] World Health Organisation (2008), Lost opportunity to complete CD4+ Lymphocytes testing among patients who tested positive for HIV in South Africa. Lost Opportunities to initiate HIV Care in South Africa. Available at (www.who.int/bulletin/volumes/88/9/09-068981.pdf).

[19] Center for Disease Control and Prevention CDC (2015), How HIV passed from one person to another. Available at (www.cdc.gov/hiv/./qa/transimissi).

[20] PLHIV (2010), Publication for People Living with HIV/AIDS. Available at (www.nephark.org).

[21] Rebecca Hodes, nam-aidmap(2010). Lost to follow-up health system failure, not patients to blame. 8th International AIDS Conference, 29th July 2010. Available at (www.aidsmap.com/loss-to-follow-up-he).

[22] Wikipedia, the free encyclopedia (2011), HIV in general. Available at (http://en.wikipedia.org/wiki/Hiv).

[23] Joint United Nations Program on HIV/AIDS (2006, 2010, 2011). Overview of the global AIDS Epidemic. UN Report on the Global AIDS epidemic. Available at (www.unaids.org/globalreport/global).

[24] International HIV/AIDS charity (2011). Averting HIV/AIDS. Available at (www.avert.org/world-aids-day.htm).

[25] Geng EH, Bangsberg DR, MUSNGUZIN (2009). Understanding reasons for and outcomes of patients lost to follow-up in anti-retroviral therapy programs in Africa through a sampling-based approach. J Acquir Immune Defic. Syndr. 2009 Sept.10.

[26] Lessels, R.J.; Mutevendzi, P.C.; Cooke, G.S.; Nowel M.L.; Retention in HIV Care for individuals not yet eligible for anti-retroviral therapy: rural KwanZulu-Natal, South Africa. J Acquir Immune Defic. Syndr 2010.

[27] Paula Braitsein (2010). XVIII International AIDS Conference of 2010. Available at (www.aids2010.org/).

[28] Cohort profile: The International epidemiological databases to evaluate AIDS (IeDEA) in Sub-Saharan Africa. Int J. Epidemiol (2011): dyr080vldy08.

[29] Amref ART hub (2011). Definition of LTFU in Pre-ART and ART. Amref ART knowledge Hub. Available at (www.hub.amref.org/index.php).

[30] Dr. Benjamin H.C.; Ronald A.C.; Albert M.; Andrew O.; Westfall.; Wilbrand M.; Mohammed L.; Lloyd B.M.; Stenttet V.; Jeffrey S.A.; A.M J Epidemiol.2010 April 15;171(8):924-931. Published online 2010 March. 10. d0i:10.1093 /aje/kw9008.

[31] Gilles V.C.; Nathan F.; Katherine H.; Eric G.; Shaheed M.; David C.; Andrew B.: PLOS ONE (2011). vol.6, issue 2; Published online 2011. Public library of science pg 9 doi: 10.1371/journal.pone.0014684. Available at (www.embase.com).