Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2010 Mar;53(3):405-11.
doi: 10.1097/QAI.0b013e3181b843f0.

Understanding reasons for and outcomes of patients lost to follow-up in antiretroviral therapy programs in Africa through a sampling-based approach

Elvin H Geng  1 , David R Bangsberg, Nicolas Musinguzi, Nneka Emenyonu, Mwebesa Bosco Bwana, Constantin T Yiannoutsos, David V Glidden, Steven G Deeks, Jeffrey N Martin
Affiliations

Understanding reasons for and outcomes of patients lost to follow-up in antiretroviral therapy programs in Africa through a sampling-based approach

Elvin H Geng et al. J Acquir Immune Defic Syndr. 2010 Mar.

Abstract

Objectives: Losses to follow-up after initiation of antiretroviral therapy (ART) are common in Africa and are a considerable obstacle to understanding the effectiveness of nascent treatment programs. We sought to characterize, through a sampling-based approach, reasons for and outcomes of patients who become lost to follow-up.

Design: Cohort study.

Methods: We searched for and interviewed a representative sample of lost patients or close informants in the community to determine reasons for and outcomes among lost patients.

Results: Three thousand six hundred twenty-eight HIV-infected adults initiated ART between January 1, 2004 and September 30, 2007 in Mbarara, Uganda. Eight hundred twenty-nine became lost to follow-up (cumulative incidence at 1, 2, and 3 years of 16%, 30%, and 39%). We sought a representative sample of 128 lost patients in the community and ascertained vital status in 111 (87%). Top reasons for loss included lack of transportation or money and work/child care responsibilities. Among the 111 lost patients who had their vital status ascertained through tracking, 32 deaths occurred (cumulative 1-year incidence 36%); mortality was highest shortly after the last clinic visit. Lower pre-ART CD4 T-cell count, older age, low blood pressure, and a central nervous system syndrome at the last clinic visit predicted deaths. Of patients directly interviewed, 83% were in care at another clinic and 71% were still using ART.

Conclusions: Sociostructural factors are the primary reasons for loss to follow-up. Outcomes among the lost are heterogeneous: both deaths and transfers to other clinics were common. Tracking a sample of lost patients is an efficient means for programs to understand site-specific reasons for and outcomes among patients lost to follow-up.

PubMed Disclaimer

Figures

FIGURE 1
FIGURE 1
Flow chart of HIV-infected patients initiating ART at the ISS clinic in Mbarara, Uganda, between January 1, 2004, and September 30, 2007.
FIGURE 2
FIGURE 2
Time to loss to follow-up among patients starting ART between January 1, 2004, and September 30, 2007. The 95% confidence bands are shown with dashed lines. Because definition of loss to follow-up required 6 months of absence, there are no events in the first 6 months.
FIGURE 3
FIGURE 3
Time to death in a sample of 111 patients lost to follow-up whose vital status was ascertained through tracking in the community. Time 0 is defined as the date of the last recorded clinic visit. The 95% CIs are shown with dashed lines.
See this image and copyright information in PMC

References

    1. Stringer JS, Zulu I, Levy J, et al. Rapid scale-up of antiretroviral therapy at primary care sites in Zambia: feasibility and early outcomes. JAMA. 2006;296:782–793. - PubMed
    1. Severe P, Leger P, Charles M, et al. Antiretroviral therapy in a thousand patients with AIDS in Haiti. N Engl J Med. 2005;353:2325–2334. - PubMed
    1. Wools-Kaloustian K, Kimaiyo S, Diero L, et al. Viability and effectiveness of large-scale HIV treatment initiatives in sub-Saharan Africa: experience from western Kenya. AIDS. 2006;20:41–48. - PubMed
    1. Office of the Unites States Global AIDS Coordinator. [Accessed 30 March 2009];The Power of Partnerships: The President’s Emergency Plan for AIDS Relief Fifth Annual Report to Congress. Available at: http://www.pepfar.gov/press/fifth_annual_report/index.htm.
    1. Rosen S, Fox MP, Gill CJ. Patient retention in antiretroviral therapy programs in sub-Saharan Africa: a systematic review. PLoS Med. 2007;4:e298. - PMC - PubMed

Publication types

Substances