Losses to follow-up of HIV-infected people in the Spanish VACH cohort over the period between 2013 and 2014: The importance of sociodemographic factors

Who is lost to follow‐up in HIV care? Assessment of care retention over time and the impact of COVID‐19. Longitudinal analysis of the PISCIS cohort

“…Class 3 of people lost to follow-up (men, born out of Spain, not diagnosed with AIDS at entry, with a detectable VL, not naïve, and not in ART in the last 12 months) was one of the most common classes across the analysis, and we speculate that this specific group of patients is typical in HIV specialized care in our context. In a study from Spain, patients who were lost to follow-up had similar socio-demographic characteristics (higher among men) and country of birth (higher among people born in countries other than Spain) [13]. Our results confirm the main pattern of LTFU of HIV care in Spain and add information on the extent to which such a pattern is maintained over time and how other groups of people lost to follow-up emerged and changed over time.…”

“…One possible explanation could be the implementation of telemedicine in Catalonia, which another study identified as reaching 56.2% during 2020 compared with 15.4% in previous years, including a shift from in‐person to phone visits in HIV outpatient care [31]. Finally, during the year 2020, the toughest year of the COVID‐19 pandemic, the class with higher rates of LTFU consisted of MSM, people born in Spain, with undetectable VL, without a diagnosis of AIDS, and receiving ART (class 7); this is in contrast to previous evidence [13] showing that more socially deprived groups were more likely to be lost to follow‐up; however, our data showed that rates of LTFU in 2019 and 2018 were similar to those of 2020; therefore, the COVID‐19 pandemic did not substantially change the pattern of LTFU from previous years.…”

“…Data from studies in Europe up to 2006 estimated that proportions of people lost to follow-up, defined as those with >1 year without follow-up, varied from 28% in the central east to 26% in the east, 25% in the south, 22% in the central west, and 18% in the north [10]. In the USA, proportions of people lost to follow-up ranged between 13% and 28% [11,12], and studies in Spain showed that proportions of loss to follow-up (LTFU) ranged between 15.5% and 18.9% [13,14].…”

“…Studies in different European countries have linked LTFU with younger age, people who inject drugs (PWID), having an immigration background, not being a man who has sex with men (MSM), having a shorter time since HIV diagnosis, and CD4+ cell counts <350 cells/μL [15][16][17][18]. In Spain, determinants of LTFU included younger age, less time in treatment, use of injecting drugs, unemployment, immigration, and being treated in a big hospital (>1000 patients in HIV care) [13]. However, these studies assessed LTFU at a single time point, and knowledge about changes over time is limited.…”

Strategies to reengage patients lost to follow up in HIV care in high income countries, a scoping review

“…In another UK study, LTFU reached 28.1% of disengagement during nine consecutive months, and further analysis of these patients showed that 26% were found as transferred to clinics outside the UK [ 10 ]. In Spain, cohort studies reported 15% of LTFU (disengaged during a minimum of 12 months) and was linked to intravenous drug use, unemployment, more sporadic sex partners, being born in another country, and not having initiated ART [ 11 ]. In Catalonia and Balearic islands, the PISCIS cohort [ 12 ] has shown that 85% of HIV-diagnosed patients were retained (defined as 1 or more visits per year) [ 13 ] and a more recent study estimated that 89% of the PLWH were diagnosed, of these 78% were under treatment and 73% are virally suppressed [ 14 ].…”