Predictors of loss to follow-up in art experienced patients in Nigeria: a 13 year review (2004–2017)

Abstract

Background Expanded access to antiretroviral therapy (ART) leads to improved HIV/AIDS treatment outcomes in Nigeria, however, increasing rates of loss to follow-up among those on ART is threatening optimal standard achievement. Therefore, this retrospective cross-sectional study is aimed at identifying correlates and predictors of loss to follow-up in patients commencing ART in a large HIV program in Nigeria. Methods Records of all patients from 432 US CDC Presidents Emergency Plan for AIDS Relief (PEPFAR) supported facilities across 10 States and FCT who started ART from 2004 to 2017 were used for this study. Bivariate and multivariate analysis of the demographic and clinical parameters of all patients was conducted using STATA version 14 to determine correlates and predictors of loss to follow-up. Results Within the review period, 245,257 patients were ever enrolled on anti-retroviral therapy. 150,191 (61.2%) remained on treatment, 10,960 (4.5%) were transferred out to other facilities, 6926 (2.8%) died, 2139 (0.9%) self-terminated treatment and 75,041 (30.6%) had a loss to follow-up event captured. Males (OR: 1.16), Non-pregnant female (OR: 4.55), Patients on ≥ 3-monthly ARV refills (OR: 1.32), Patients with un-suppressed viral loads on ART (OR: 4.52), patients on adult 2nd line regimen (OR: 1.23) or pediatric on 1st line regimen (OR: 1.70) were significantly more likely to be lost to follow-up. Conclusion Despite increasing access to anti-retroviral therapy, loss to follow-up is still a challenge in the HIV program in Nigeria. Differentiated care approaches that will focus on males, non-pregnant females and paediatrics is encouraged. Reducing months of Anti-retroviral drug refill to less than 3 months is advocated for increased patient adherence.

Factors Associated With An Interruption in Treatment of People Living With HIV in USAID-Supported States in Nigeria: A Retrospective Study From 2000‒2020

“…Age and sex were shown to not have a considerable association with treatment interruption when compared and adjusted for the other variables in our study, results similar to those found in other studies which did not nd a stronger association of older age with IIT [22]. Other studies which did associate an elder age group with IIT explained the occurrence as a possible re ection of inaccurate classi cation of IIT after the clients' death [9]. Earlier studies have shown a higher likelihood for males to interrupt treatment and recommended male-targeted interventions [9,13]; this may have resulted in improved odds for males to adhere to treatment.…”

“…Findings from a similar study indicated 49% of clients on one-month regimens had interrupted treatment [9], while that proportion was 50% in this cohort. The higher proportion of ART interruptions associated with shorter dispensing durations can be explained by the requirement for frequent visits for the client that was associated with a higher rate of ART interruption [19].…”

“…Similar studies have been carried out at different times in differrent areas of Nigeria. Out study contributes to the understanding of IIT in Nigeria [9,13].…”

“…Clients are considered to have interrupted treatment when they are no longer receiving ART and have had no recorded clinical contact for 28 days after the last scheduled appointment [13] or expected clinical contact. There are several factors associated with clients interrupting treatment, such as their age, gender, CD4 count, and geographical location [9,10]. Potential risk factors identi ed in various studies include clients' educational level, the lack of a telephone, and risky sexual behaviour [8,11,12].…”

Incidence and Predictors of Loss-to-follow-up Among Pregnant and Breastfeeding Women on Option B+ PMTCT Program in Northwest Ethiopia: a Retrospective Follow-up Study.

“…This study also found that women who had no baseline viral load measurement were more likely to be LTFU as compared with those who had baseline viral load measurement within three-month of PMTCT enrollment. This nding is supported by a study in Nigeria among general population which was missing viral load measurement affects LTFU (49). This might be due to the fact that when viral load measurement took during PMTCT enrolment, the health care provider classi ed women as high risk with viral load more than 1000 copies/mm 3 and low risk with viral load less than 1000copies/mm 3 .…”