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Loss to follow-up before and after initiation of antiretroviral therapy in HIV facilities in Lilongwe, Malawi.

Abstract Although several studies have explored factors associated with loss to follow-up (LTFU) from HIV care, there remains a gap in understanding how these factors vary by setting, volume of patient and patients' demographic and clinical characteristics. We determined rates and factors associated with LTFU in HIV care Lilongwe, Malawi.
PMID
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Authors

Mayor MeshTerms
Keywords
Journal Title plos one
Publication Year Start




PMID- 29373574
OWN - NLM
STAT- In-Process
LR  - 20180126
IS  - 1932-6203 (Electronic)
IS  - 1932-6203 (Linking)
VI  - 13
IP  - 1
DP  - 2018
TI  - Loss to follow-up before and after initiation of antiretroviral therapy in HIV
      facilities in Lilongwe, Malawi.
PG  - e0188488
LID - 10.1371/journal.pone.0188488 [doi]
AB  - INTRODUCTION: Although several studies have explored factors associated with loss
      to follow-up (LTFU) from HIV care, there remains a gap in understanding how these
      factors vary by setting, volume of patient and patients' demographic and clinical
      characteristics. We determined rates and factors associated with LTFU in HIV care
      Lilongwe, Malawi. METHODS: We conducted a retrospective cohort study of
      HIV-infected individuals aged 15 years or older at the time of registration for
      HIV care in 12 ART facilities, between April 2012 and March 2013. HIV-positive
      individuals who had not started ART (pre-ART patients) were clinically assessed
      to determine ART eligibility at registration and during clinic follow-up visits. 
      ART-eligible patients were initiated on triple antiretroviral combination. Study 
      data were abstracted from patients' cards, facility ART registers or electronic
      medical record system from the date of registration for HIV care to a maximum
      follow-up period of 24 months. Descriptive statistics were undertaken to
      summarize characteristics of the study patients. Separate univariable and
      multivariable poisson regression models were used to explore factors associated
      with LTFU in pre-ART and ART care. RESULTS: A total of 10,812 HIV-infected
      individuals registered for HIV care. Of these patients, 1,907 (18%) and 8,905
      (82%) enrolled in pre-ART and ART care, respectively. Of the 1,907 pre-ART
      patients, 490 (26%) subsequently initiated ART and were included in both the
      pre-ART and ART analyses. The LTFU rates among patients in pre-ART and ART care
      were 48 and 26 per 100 person-years, respectively. Of the 9,105 ART patients with
      reasons for starting ART, 2,451 (27%) were initiated on ART because of pregnancy 
      or breastfeeding (Option B+) status. Multivariable analysis showed that being
      >/=35 years and female were associated with decreased risk of LTFU in the pre-ART
      and ART phases of HIV care. However, being in WHO clinical stage 3 (adjusted risk
      ratio (aRR) 1.35, 95% confidence interval (CI): 1.20-1.51) and stage 4 (aRR 1.87,
      95% CI: 1.62-2.18), body mass index </= 18.4 (aRR 1.24, 95% CI: 1.11-1.39) at ART
      initiation, poor adherence to clinic appointments (aRR 4.55, 95% CI: 4.16-4.97)
      and receiving HIV care in rural facilities (aRR 2.32, 95% CI: 1.94-2.87) were
      associated with increased risk of LTFU among ART patients. Being re-initiated on 
      ART once (aRR 0.20, 95% CI: 0.17-0.22), more than once (aRR 0.06, 95% CI:
      0.05-0.07), and being enrolled at a low-volume facility (aRR 0.25, 95% CI:
      0.20-0.30) were associated with decreased risk of LTFU from ART care. CONCLUSION:
      A sizeable proportion of ART LTFU occurred among women enrolled during pregnancy 
      or breast-feeding. Non- compliance to clinic and receiving ART in a rural
      facility or high-volume facility were associated with increased risk of LTFU from
      ART care. Developing effective interventions that target high-risk subgroups and 
      contexts may help reduce LTFU from HIV care.
FAU - Tweya, Hannock
AU  - Tweya H
AD  - The International Union Against Tuberculosis and Lung Disease, Paris, France.
AD  - Lighthouse Trust, Lilongwe, Malawi.
FAU - Oboho, Ikwo Kitefre
AU  - Oboho IK
AD  - Division of Global HIV and Tuberculosis (DGHT), Center for Global Health, Centers
      for Disease Control and Prevention (CDC), Atlanta, Georgia, United States of
      America.
FAU - Gugsa, Salem T
AU  - Gugsa ST
AD  - Lighthouse Trust, Lilongwe, Malawi.
AD  - International Training and Education Center for Health (I-TECH), Lilongwe,
      Malawi.
FAU - Phiri, Sam
AU  - Phiri S
AD  - Lighthouse Trust, Lilongwe, Malawi.
AD  - Department of Public Health, School of Public Health and Family Medicine, College
      of Medicine, University of Malawi, Lilongwe, Malawi.
AD  - Department of Medicine, School of Medicine, University of North Carolina Chapel
      Hill, Chapel Hill, NC, United States of America.
FAU - Rambiki, Ethel
AU  - Rambiki E
AD  - Bwaila Hospital, Ministry of Health, Lilongwe, Malawi.
FAU - Banda, Rebecca
AU  - Banda R
AD  - Lighthouse Trust, Lilongwe, Malawi.
FAU - Mwafilaso, Johnbosco
AU  - Mwafilaso J
AD  - Lighthouse Trust, Lilongwe, Malawi.
FAU - Munthali, Chimango
AU  - Munthali C
AD  - Baobab Health Trust, Lilongwe, Malawi.
FAU - Gupta, Sundeep
AU  - Gupta S
AD  - Division of Global HIV and Tuberculosis (DGHT), Center for Global Health, Centers
      for Disease Control and Prevention (CDC), Lilongwe, Malawi.
FAU - Bateganya, Moses
AU  - Bateganya M
AD  - Division of Global HIV and Tuberculosis (DGHT), Center for Global Health, Centers
      for Disease Control and Prevention (CDC), Atlanta, Georgia, United States of
      America.
FAU - Maida, Alice
AU  - Maida A
AD  - Division of Global HIV and Tuberculosis (DGHT), Center for Global Health, Centers
      for Disease Control and Prevention (CDC), Lilongwe, Malawi.
LA  - eng
PT  - Journal Article
PT  - Research Support, Non-U.S. Gov't
DEP - 20180126
PL  - United States
TA  - PLoS One
JT  - PloS one
JID - 101285081
EDAT- 2018/01/27 06:00
MHDA- 2018/01/27 06:00
CRDT- 2018/01/27 06:00
PHST- 2016/12/05 00:00 [received]
PHST- 2017/11/08 00:00 [accepted]
PHST- 2018/01/27 06:00 [entrez]
PHST- 2018/01/27 06:00 [pubmed]
PHST- 2018/01/27 06:00 [medline]
AID - 10.1371/journal.pone.0188488 [doi]
AID - PONE-D-16-48149 [pii]
PST - epublish
SO  - PLoS One. 2018 Jan 26;13(1):e0188488. doi: 10.1371/journal.pone.0188488.
      eCollection 2018.