Determinants of loss to follow-up in patients on antiretroviral treatment, South Africa, 2004–2012: a cohort studyReport as inadecuate

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BMC Health Services Research

, 15:259

First Online: 04 July 2015Received: 04 September 2014Accepted: 08 June 2015DOI: 10.1186-s12913-015-0912-2

Cite this article as: Mberi, M.N., Kuonza, L.R., Dube, N.M. et al. BMC Health Serv Res 2015 15: 259. doi:10.1186-s12913-015-0912-2


BackgroundThe number of Human Immunodeficiency Virus HIV infected people eligible for initiation on antiretroviral Therapy ART is increasing. ART programmatic success requires that patients who are taking ART remain on treatment and are followed up regularly. This study investigated factors associated with being lost to follow-up, in a cohort of patients enrolled in a pharmacovigilance study in South Africa.

MethodsThis was a retrospective observational cohort study performed at one of the Medunsa National Pharmacovigilance Centre’s MNPC ART sentinel surveillance sites. Loss to Follow-up LTFU was defined as -a patient who had been followed up at the sentinel site, who had not had contact with the health facility for 180 days or more since their last recorded expected date of return or if there were 180 days or more between the expected date of return and the next clinic visit-.

ResultsOut of 595 patients, 65.5 % n = 390 were female and 23.4 % n = 139 were LTFU. The median time on ART before LTFU was 21.5 months interquartile range: 12.9 – 34.7 months. The incidence rate of LTFU was 103 per 1000 person-years in the first year on ART and increased to 405 per 1000 person-years in the eighth year of taking ART. Factors associated with becoming LTFU included not having a committed partner Adjusted Hazard Ratio aHR: 2.9, 95 % Confidence Interval CI:1.19-6.97, p = 0.019, being self-employed aHR: 13.9, 95 % CI:2.81 - 69.06, p = 0.001, baseline CD4 count > 200 cells-ml aHR: 3.8, 95 % CI: 1.85-7.85, p < 0.001, detectable last known Viral Load VL aHR: 3.6, 95 % CI:1.98 - 6.52, p < 0.001 and a last known World Health Organisation clinical stage three or four aHR: 2.0, 95 % CI:1.22-3.27, p = 0.006. Patients that previously had an ART adverse event had a lower risk aHR: 0.6, 95 % CI: 0.38 - 0.99, p = 0.044 of becoming LTFU than those that had not.

ConclusionThe incidence rate of LTFU increases with additional years on ART. Intensified measures to improve patient retention on ART must be prioritised with increasing patient time on ART and in patients that are at increased risk of becoming lost to follow-up.

KeywordsLoss to follow-up Surveillance cohort Medunsa National Pharmacovigilance Centre Antiretroviral therapy AbbreviationsARTAntiretroviral Therapy

CIConfidence Interval

CRFCase Report Form

d4t Stavudine

HIVHuman Immunodeficiency Virus

HRHazard Ratio

aHRAdjusted Hazards Ratio

IQRInterquartile Range

LTFULoss To Follow-Up

MNPCMedunsa National Pharmacovigilance Centre

NDoHNational Department of Health


UNAIDSUnited Nations program on HIV-AIDS

VLViral Load

WHOWorld Health Organisation

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Author: Mazvita Naome Mberi - Lazarus Rugare Kuonza - Nomathemba Michelle Dube - Cornelius Nattey - Samuel Manda - Robert Summers


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