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Tracing People Living With Human Immunodeficiency Virus Who Are Lost to Follow-up at Antiretroviral Therapy Programs in Southern Africa: A Sampling-Based Cohort Study in 6 Countries.
- Source :
- Clinical Infectious Diseases; 1/15/2022, Vol. 74 Issue 2, p171-179, 9p
- Publication Year :
- 2022
-
Abstract
- Background Attrition threatens the success of antiretroviral therapy (ART). In this cohort study, we examined outcomes of people living with human immunodeficiency virus (PLHIV) who were lost to follow-up (LTFU) during 2014–2017 at ART programs in Southern Africa. Methods We confirmed LTFU (missed appointment for ≥60 or ≥90 days, according to local guidelines) by checking medical records and used a standardized protocol to trace a weighted random sample of PLHIV who were LTFU in 8 ART programs in Lesotho, Malawi, Mozambique, South Africa, Zambia, and Zimbabwe, 2017–2019. We ascertained vital status and identified predictors of mortality using logistic regression, adjusted for sex, age, time on ART, time since LTFU, travel time, and urban or rural setting. Results Among 3256 PLHIV, 385 (12%) were wrongly categorized as LTFU and 577 (17%) had missing contact details. We traced 2294 PLHIV (71%) by phone calls, home visits, or both: 768 (34% of 2294) were alive and in care, including 385 (17%) silent transfers to another clinic; 528 (23%) were alive without care or unknown care; 252 (11%) had died. Overall, the status of 1323 (41% of 3256) PLHIV remained unknown. Mortality was higher in men than women, higher in children than in young people or adults, and higher in PLHIV who had been on ART <1 year or LTFU ≥1 year and those living farther from the clinic or in rural areas. Results were heterogeneous across sites. Conclusions Our study highlights the urgent need for better medical record systems at HIV clinics and rapid tracing of PLHIV who are LTFU. [ABSTRACT FROM AUTHOR]
- Subjects :
- MORTALITY risk factors
HIV infections
PATIENT aftercare
HIV-positive persons
EVALUATION of medical care
TELEPHONES
HOME care services
AGE distribution
TRAVEL
ANTIRETROVIRAL agents
POPULATION geography
HEALTH status indicators
GOVERNMENT programs
MEDICAL protocols
RISK assessment
SEX distribution
MEDICAL records
DESCRIPTIVE statistics
PATIENT compliance
CONTACT tracing
MEDICAL appointments
STATISTICAL sampling
LOGISTIC regression analysis
RESIDENTIAL patterns
LONGITUDINAL method
Subjects
Details
- Language :
- English
- ISSN :
- 10584838
- Volume :
- 74
- Issue :
- 2
- Database :
- Complementary Index
- Journal :
- Clinical Infectious Diseases
- Publication Type :
- Academic Journal
- Accession number :
- 154976187
- Full Text :
- https://doi.org/10.1093/cid/ciab428