Limits...
Determinants of loss to follow-up in patients on antiretroviral treatment, South Africa, 2004-2012: a cohort study.

Mberi MN, Kuonza LR, Dube NM, Nattey C, Manda S, Summers R - BMC Health Serv Res (2015)

Bottom Line: Factors associated with becoming LTFU included not having a committed partner (Adjusted Hazard Ratio (aHR): 2.9, 95% Confidence Interval (CI):1.19-6.97, p = 0.019), being self-employed (aHR: 13.9, 95% CI:2.81 - 69.06, p = 0.001), baseline CD4 count > 200 cells/ml (aHR: 3.8, 95% CI: 1.85-7.85, p < 0.001), detectable last known Viral Load (VL) (aHR: 3.6, 95% CI:1.98-6.52, p < 0.001) and a last known World Health Organisation clinical stage three or four (aHR: 2.0, 95% CI:1.22-3.27, p = 0.006).The incidence rate of LTFU increases with additional years on ART.Intensified measures to improve patient retention on ART must be prioritised with increasing patient time on ART and in patients that are at increased risk of becoming lost to follow-up.

View Article: PubMed Central - PubMed

Affiliation: South African Field Epidemiology Training Programme, National Institute for Communicable Diseases of the National Health Laboratory Services, 1 Modderfontein Road, Monument Park 0105, Post net suite 179, P/bag X27923, Sandringham, South Africa. mazvita1979@gmail.com.

ABSTRACT

Background: The number of Human Immunodeficiency Virus (HIV) infected people eligible for initiation on antiretroviral Therapy (ART) is increasing. ART programmatic success requires that patients who are taking ART remain on treatment and are followed up regularly. This study investigated factors associated with being lost to follow-up, in a cohort of patients enrolled in a pharmacovigilance study in South Africa.

Methods: This was a retrospective observational cohort study performed at one of the Medunsa National Pharmacovigilance Centre's (MNPC) ART sentinel surveillance sites. Loss to Follow-up (LTFU) was defined as "a patient who had been followed up at the sentinel site, who had not had contact with the health facility for 180 days or more since their last recorded expected date of return or if there were 180 days or more between the expected date of return and the next clinic visit".

Results: Out of 595 patients, 65.5% (n = 390) were female and 23.4% (n = 139) were LTFU. The median time on ART before LTFU was 21.5 months (interquartile range: 12.9 - 34.7 months). The incidence rate of LTFU was 103 per 1000 person-years in the first year on ART and increased to 405 per 1000 person-years in the eighth year of taking ART. Factors associated with becoming LTFU included not having a committed partner (Adjusted Hazard Ratio (aHR): 2.9, 95% Confidence Interval (CI):1.19-6.97, p = 0.019), being self-employed (aHR: 13.9, 95% CI:2.81 - 69.06, p = 0.001), baseline CD4 count > 200 cells/ml (aHR: 3.8, 95% CI: 1.85-7.85, p < 0.001), detectable last known Viral Load (VL) (aHR: 3.6, 95% CI:1.98-6.52, p < 0.001) and a last known World Health Organisation clinical stage three or four (aHR: 2.0, 95% CI:1.22-3.27, p = 0.006). Patients that previously had an ART adverse event had a lower risk (aHR: 0.6, 95% CI: 0.38 - 0.99, p = 0.044) of becoming LTFU than those that had not.

Conclusion: The incidence rate of LTFU increases with additional years on ART. Intensified measures to improve patient retention on ART must be prioritised with increasing patient time on ART and in patients that are at increased risk of becoming lost to follow-up.

Show MeSH

Related in: MedlinePlus

Kaplan Meier graph showing the probability of remaining in care with time, Tshepang Pharmacovigilance cohort, 2004–2012
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
getmorefigures.php?uid=PMC4491264&req=5

Fig2: Kaplan Meier graph showing the probability of remaining in care with time, Tshepang Pharmacovigilance cohort, 2004–2012

Mentions: The data of the 595 patients that we included in the study represented 1280 person-years of follow up time. The overall incidence rate of LTFU in the cohort was estimated to be 109 per 1000 person-years (95 % Confidence Interval (CI): 92–128). Among the patients LTFU, the median duration on follow up was 21.5 months (inter-quartile range (IQR): 12.9 - 34.7). Patient retention in care was 81.8 % at 2 years and 54.7 % at 5 years in the cohort as illustrated in Fig. 2.Fig. 2


Determinants of loss to follow-up in patients on antiretroviral treatment, South Africa, 2004-2012: a cohort study.

Mberi MN, Kuonza LR, Dube NM, Nattey C, Manda S, Summers R - BMC Health Serv Res (2015)

Kaplan Meier graph showing the probability of remaining in care with time, Tshepang Pharmacovigilance cohort, 2004–2012
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4491264&req=5

Fig2: Kaplan Meier graph showing the probability of remaining in care with time, Tshepang Pharmacovigilance cohort, 2004–2012
Mentions: The data of the 595 patients that we included in the study represented 1280 person-years of follow up time. The overall incidence rate of LTFU in the cohort was estimated to be 109 per 1000 person-years (95 % Confidence Interval (CI): 92–128). Among the patients LTFU, the median duration on follow up was 21.5 months (inter-quartile range (IQR): 12.9 - 34.7). Patient retention in care was 81.8 % at 2 years and 54.7 % at 5 years in the cohort as illustrated in Fig. 2.Fig. 2

Bottom Line: Factors associated with becoming LTFU included not having a committed partner (Adjusted Hazard Ratio (aHR): 2.9, 95% Confidence Interval (CI):1.19-6.97, p = 0.019), being self-employed (aHR: 13.9, 95% CI:2.81 - 69.06, p = 0.001), baseline CD4 count > 200 cells/ml (aHR: 3.8, 95% CI: 1.85-7.85, p < 0.001), detectable last known Viral Load (VL) (aHR: 3.6, 95% CI:1.98-6.52, p < 0.001) and a last known World Health Organisation clinical stage three or four (aHR: 2.0, 95% CI:1.22-3.27, p = 0.006).The incidence rate of LTFU increases with additional years on ART.Intensified measures to improve patient retention on ART must be prioritised with increasing patient time on ART and in patients that are at increased risk of becoming lost to follow-up.

View Article: PubMed Central - PubMed

Affiliation: South African Field Epidemiology Training Programme, National Institute for Communicable Diseases of the National Health Laboratory Services, 1 Modderfontein Road, Monument Park 0105, Post net suite 179, P/bag X27923, Sandringham, South Africa. mazvita1979@gmail.com.

ABSTRACT

Background: The number of Human Immunodeficiency Virus (HIV) infected people eligible for initiation on antiretroviral Therapy (ART) is increasing. ART programmatic success requires that patients who are taking ART remain on treatment and are followed up regularly. This study investigated factors associated with being lost to follow-up, in a cohort of patients enrolled in a pharmacovigilance study in South Africa.

Methods: This was a retrospective observational cohort study performed at one of the Medunsa National Pharmacovigilance Centre's (MNPC) ART sentinel surveillance sites. Loss to Follow-up (LTFU) was defined as "a patient who had been followed up at the sentinel site, who had not had contact with the health facility for 180 days or more since their last recorded expected date of return or if there were 180 days or more between the expected date of return and the next clinic visit".

Results: Out of 595 patients, 65.5% (n = 390) were female and 23.4% (n = 139) were LTFU. The median time on ART before LTFU was 21.5 months (interquartile range: 12.9 - 34.7 months). The incidence rate of LTFU was 103 per 1000 person-years in the first year on ART and increased to 405 per 1000 person-years in the eighth year of taking ART. Factors associated with becoming LTFU included not having a committed partner (Adjusted Hazard Ratio (aHR): 2.9, 95% Confidence Interval (CI):1.19-6.97, p = 0.019), being self-employed (aHR: 13.9, 95% CI:2.81 - 69.06, p = 0.001), baseline CD4 count > 200 cells/ml (aHR: 3.8, 95% CI: 1.85-7.85, p < 0.001), detectable last known Viral Load (VL) (aHR: 3.6, 95% CI:1.98-6.52, p < 0.001) and a last known World Health Organisation clinical stage three or four (aHR: 2.0, 95% CI:1.22-3.27, p = 0.006). Patients that previously had an ART adverse event had a lower risk (aHR: 0.6, 95% CI: 0.38 - 0.99, p = 0.044) of becoming LTFU than those that had not.

Conclusion: The incidence rate of LTFU increases with additional years on ART. Intensified measures to improve patient retention on ART must be prioritised with increasing patient time on ART and in patients that are at increased risk of becoming lost to follow-up.

Show MeSH
Related in: MedlinePlus