Introduction: Loss to follow-up (LTFU) rates from antiretroviral treatment (ART) programmes in low- and middle-income countries (LMIC) are high, leading to poor treatment outcomes and onward transmission of HIV. Knowledge of risk factors is required to address LTFU. In this systematic review, risk factors for LTFU are identified and meta-analyses performed. Methods: PubMed, Embase, Psycinfo and Cochrane were searched for studies that report on potential risk factors for LTFU in adults who initiated ART in LMICs. Meta-analysis was performed for risk factors evaluated by at least five studies. Pooled effect estimates and their 95% confidence intervals (95% CI) were calculated using random effect models with inverse variance weights. Risk of bias was assessed and sensitivity analyses performed. Results: Eighty studies were included describing a total of 1 605 320 patients of which 87.4% from sub-Saharan Africa. The following determinants were significantly associated with an increased risk of LTFU in meta-analysis: male sex, older age, being single, unemployment, lower educational status, advanced WHO stage, low weight, worse functional status, poor adherence, nondisclosure, not receiving cotrimoxazole prophylactic therapy when indicated, receiving care at secondary level and more recent year of initiation. No association was seen for CD4+ cell count, tuberculosis at baseline, regimen, and geographical setting. Conclusion: There are several sociodemographic, clinical, patient behaviour, treatment-related and system level risk factors for LTFU from ART programs. Knowledge of risk factors should be used to better target retention interventions and develop tools to identify high-risk patients.
Background Military aircrew are subjected to both stress and excessive G-forces, which may be associated with an increased risk of coronary artery disease (CAD) and sudden cardiac death. Annual cardiac screening has therefore been implicated using exercise testing, which suffers from both false-positive and false-negative results. In this study, we have evaluated the prevalence of CAD in military aircrew using cardiac computed tomography (CT), and assessed whether cardiac CT would be a useful screening tool within this population. Methods Prospective, single-center, cohort study in 250 asymptomatic aircrew >40 years old in the Royal Netherlands Air Force. Included subjects underwent cardiac CT, in addition to the routine annual check-up that included an electrocardiogram, exercise test and laboratory analysis. Primary endpoint was obstructive CAD, defined as a coronary stenosis ≥50%. Secondary endpoints were non-obstructive CAD (<50% stenosis) and coronary artery calcium score (CACS) >100. Results Of the first 108 inclusions, mean age was 49 years (range 40–57), 99% were male and mean body mass index was 25.8 (SD 2.6). The prevalence of hypertension was 8%, hypercholesterolemia 9% and familial heart disease was noted in 22%. 16% were active smokers and none had diabetes. Obstructive CAD was observed in 2% of patients, non-obstructive CAD in 40% and CACS >100 in 11%. All subjects with obstructive CAD on cardiac CT underwent coronary artery angiography, which confirmed a stenosis >70% that required revascularization. Conclusion In asymptomatic military aviation aircrew >40 years old currently active in the Royal Netherlands Air Force, the prevalence of obstructive and non-obstructive CAD was 2% and 40%, respectively Acknowledgement/Funding Royal Netherlands Air Force
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