Factors associated with loss to clinic among HIV patients not yet known to be eligible for antiretroviral therapy (ART) in Mozambique

Abstract

IntroductionRetention in HIV care prior to ART initiation is generally felt to be suboptimal, but has not been well-characterized.MethodsWe examined data on 37,352 adult pre-ART patients (ART ineligible or unknown eligibility) who enrolled in care during 2005–2008 with >1 clinical visit at 23 clinics in Mozambique. We defined loss to clinic (LTC) as >12 months since the last visit among those not known to have died/transferred. Cox proportional-hazards models were used to examine factors associated with LTC, accounting for clustering within sites.ResultsOf 37,352 pre-ART patients, 61% had a CD4 count within three months of enrolment (median CD4: 452, IQR: 345–611). 17,598 (47.1%) were ART ineligible and 19,754 (52.9%) were of unknown eligibility status at enrolment because of missing information on CD4 count and/or WHO stage. Kaplan-Meier estimates for LTC at 12 months were 41% (95% CI: 40.2–41.8) and 48% (95% CI: 47.2–48.8), respectively. Factors associated with LTC among ART ineligible patients included male sex (AHRmen_vs_non-pregnant women: 1.5; 95% CI: 1.4–1.6) and being pregnant at enrolment (AHRpregnant_vs_non-pregnant women: 1.3; 95% CI: 1.1–1.5). Older age, more education, higher weight and more advanced WHO stage at enrolment were independently associated with lower risks of LTC. Similar findings were observed among patients whose ART eligibility status was unknown at enrolment.ConclusionsSubstantial LTC occurred prior to ART initiation among patients not yet known to be eligible for ART, including nearly half of patients without documented ART eligibility assessment. Interventions are needed to target pre-ART patients who may be at higher risk for LTC, including pregnant women and patients with less advanced HIV disease.

Observational Study of the Effect of Patient Outreach on Return to Care: The Earlier the Better

“…Our observations recapitulate differences and patterns noted in studies assessing programmatic retention in care, as older age and lower CD4 count at enrollment and/or at ART initiation have previously been reported as strongly associated with better retention in care within similar settings (28,39–41) A notable difference of our study compared to previous reports is that our inferences were made with reference to a population already lost to clinic, versus the entire population engaged in care, which might be susceptible to saturation of treatment effect because individuals continuously retained in the entire population may not derive additional benefit from outreach efforts (e.g., appointment reminders) directed at them.…”

HIV Care and Treatment Beliefs among Patients Initiating Antiretroviral Treatment (ART) in Oromia, Ethiopia

“…Previous research has found higher rates of defaulting from HIV care [33] and declines in ART adherence during the perinatal and post-delivery periods [34–36], which has been attributed to conflicting priorities of new mothers, less interaction with the healthcare system post-delivery, and postpartum depression [37]. Our finding may suggest that even before delivery, pregnant women’s belief in the need for long-term HIV care and treatment may be undercut by the belief in the curative power of Holy Water.…”

SMSaúde: Evaluating Mobile Phone Text Reminders to Improve Retention in HIV Care for Patients on Antiretroviral Therapy in Mozambique

“…26 To ensure data quality, the electronic database contains rules for validating input data (e.g., maximum and minimum limits on numerous variables, maximum number of characters). At each study site, data were saved daily on a back-up drive.…”