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. 2014 Aug 6;1(2):ofu055.
doi: 10.1093/ofid/ofu055. eCollection 2014 Sep.

Time-Dependent Predictors of Loss to Follow-Up in a Large HIV Treatment Cohort in Nigeria

Seema Thakore Meloni  1 , Charlotte Chang  1 , Beth Chaplin  1 , Holly Rawizza  2 , Oluwatoyin Jolayemi  3 , Bolanle Banigbe  3 , Prosper Okonkwo  3 , Phyllis Kanki  1
Affiliations

Time-Dependent Predictors of Loss to Follow-Up in a Large HIV Treatment Cohort in Nigeria

Seema Thakore Meloni et al. Open Forum Infect Dis. .

Abstract

Background: Most evaluations of loss to follow-up (LTFU) in human immunodeficiency virus (HIV) treatment programs focus on baseline predictors, prior to antiretroviral therapy (ART) initiation. As risk of LTFU is a continuous issue, the aim of this evaluation was to augment existing information with further examination of time-dependent predictors of loss.

Methods: This was a retrospective evaluation of data collected between 2004 and 2012 by the Harvard School of Public Health and the AIDS Prevention Initiative in Nigeria as part of PEPFAR-funded program in Nigeria. We used multivariate modeling methods to examine associations between CD4(+) cell counts, viral load, and early adherence patterns with LTFU, defined as no refills collected for at least 2 months since the last scheduled appointment.

Results: Of 51 953 patients initiated on ART between 2004 and 2011, 14 626 (28%) were LTFU by 2012. Factors associated with increased risk for LTFU were young age, having nonincome-generating occupations or no education, being unmarried, World Health Organization (WHO) stage, having a detectable viral load, and lower CD4(+) cell counts. In a subset analysis, adherence patterns during the first 3 months of ART were associated with risk of LTFU by month 12.

Conclusions: In settings with limited resources, early adherence patterns, as well as CD4(+) cell counts and unsuppressed viral load, at any time point in treatment are predictive of loss and serve as effective markers for developing targeted interventions to reduce rates of attrition.

Keywords: ART outcomes; HIV; attrition; loss to follow-up; retention.

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Figures

Fig. 1.
Fig. 1.
Flow diagram for patients included in this evaluation. Abbreviations: ART, antiretroviral therapy; ARV, antiretroviral; HIV, human immunodeficiency virus; 1L, first-line.
Fig. 2.
Fig. 2.
CD4+ cell counts and viral loads predict LTFU in time-dependent manner. Abbreviations: ART, antiretroviral therapy; LTFU, loss to follow-up; VL, viral load.
Fig. 3.
Fig. 3.
Results from random effects logistic regression model with multiple imputations examining association between early adherence patterns and LTFU by M12 post-initiation of ART. Abbreviations: ART, antiretroviral therapy; LTFU, loss to follow-up; M12, month 12.
See this image and copyright information in PMC

References

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