Factors Associated with Loss to Follow-up among Patients Receiving HIV Treatment in Nairobi, Kenya

Abstract Background: The scale-up of HIV treatment programs has resulted in a reduction in HIV-related morbidity and mortality. However, retention of patients in these programs remains a challenge in sub-Saharan Africa. Understanding factors associated with loss to follow-up (LTFU) and mortality outcomes is therefore important to inform targeted program interventions. Methods: A retrospective multi-cohort analysis of 23,890 adult patients on ART over 36 months of follow-up in Kenya was done. Multivariate logistic regression analysis was done to assess for factors associated with LTFU and mortality at 6, 12, 24, and 36 months of follow-up. Results: Majority, 67.7%, were female. At 36 months , 27.2% were LTFU and 13.5% had died. Factors associated with mortality at 36 months included older age (51 years and above) using 20-35 years as reference [(adjusted odds ratio [aOR], 1.51, 95% confidence interval (CI) 1.23–1.86, p<0.001], being male (aOR, 1.59, 95% CI 1.39–1.83, p<0.001), divorced using married as reference (aOR, 1.86, 95% CI 1.56–2.22, p<0.001), having a body mass index (BMI) score of less than 18.5 kg/m² using 18.5-24.9 kg/m² as reference (aOR = 1.79, 95% CI 1.52–2.11, p<0.001), and, World Health Organization stage III and IV using stage I as the reference (aOR, 1.94, 95% CI 1.43–2.63 and aOR, 4.24, 95% CI 3.06–5.87, p<0.001 respectively). Factors associated with LTFU at 36 months included being young between 20-35 years (aOR, 1.49, 95% CI 1.40-1.59, p<0.001) using 36-50 years as reference, being male (aOR, 1.19, 95% CI 1.12–1.27, p<0.001), and being single or divorced using married as reference (aOR, 1.34, 95% CI 1.23–1.45 and aOR, 1.25, 95% CI 1.15–1.36, p<0.001 respectively). Patients with baseline BMI of less than 18.5 kg/m² using normal BMI as reference (aOR, 1.68, 95% CI 1.39–2.02, p<0.001) were also likely to be LTFU. Conclusions: Factors associated with LTFU and mortality were generally similar over time. Implementation of HIV treatment programs should therefore be tailored based on gender, age profiles, nutritional, and, marital status of patients. In addition, programs should focus on the care of older patients to reduce the risk of mortality.

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Factors associated with 36-month loss to follow-up and mortality outcomes among HIV-infected adults on antiretroviral therapy in Central Kenya

10.21203/rs.2.18191/v2 ◽

2020 ◽

Author(s):

Paul Wekesa ◽

Angela McLigeyo ◽

Kevin Owuor ◽

Jonathan Mwangi ◽

Evelyn Nganga ◽

...

Keyword(s):

Cohort Analysis ◽

Scale Up ◽

Multivariate Logistic Regression Analysis ◽

Hiv Treatment ◽

Sub Saharan Africa ◽

World Health ◽

Treatment Programs ◽

Loss To Follow Up ◽

Factors Associated

Abstract Background : The scale-up of HIV treatment programs has resulted in a reduction in HIV-related morbidity and mortality. However, retention of patients in these programs remains a challenge in sub-Saharan Africa. Understanding factors associated with loss to follow-up (LTFU) and mortality outcomes is therefore important to inform targeted program interventions. Methods : A retrospective multi-cohort analysis of 23,890 adult patients on ART over 36 months of follow-up in Kenya was done. Multivariate logistic regression analysis was done to assess for factors associated with LTFU and mortality at 6, 12, 24, and 36 months of follow-up. Results : Majority, 67.7%, were female. At 36 months , 27.2% were LTFU and 13.5% had died. Factors associated with mortality at 36 months included older age (51 years and above) using 20-35 years as reference [(adjusted odds ratio [aOR], 1.51, 95% confidence interval (CI) 1.23–1.86, p<0.001], being male (aOR, 1.59, 95% CI 1.39–1.83, p<0.001), divorced using married as reference (aOR, 1.86, 95% CI 1.56–2.22, p<0.001), having a body mass index (BMI) score of less than 18.5 kg/m² using 18.5-24.9 kg/m² as reference (aOR = 1.79, 95% CI 1.52–2.11, p<0.001), and, World Health Organization stage III and IV using stage I as the reference (aOR, 1.94, 95% CI 1.43–2.63 and aOR, 4.24, 95% CI 3.06–5.87, p<0.001 respectively). Factors associated with LTFU at 36 months included being young between 20-35 years (aOR, 1.49, 95% CI 1.40-1.59, p<0.001) using 36-50 years as reference, being male (aOR, 1.19, 95% CI 1.12–1.27, p<0.001), and being single or divorced using married as reference (aOR, 1.34, 95% CI 1.23–1.45 and aOR, 1.25, 95% CI 1.15–1.36, p<0.001 respectively). Patients with baseline BMI of less than 18.5 kg/m² using normal BMI as reference (aOR, 1.68, 95% CI 1.39–2.02, p<0.001) were also likely to be LTFU. Conclusions : Factors associated with LTFU and mortality were generally similar over time. Implementation of programs in similar settings should be tailored to gender, age profiles, nutritional, and, marital status of patients to address LTFU. In addition, programs should focus on the care of older patients to reduce the risk of mortality.

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Factors Associated With Loss-To-Follow-Up Of Hiv-Positive Mothers And Their Infants Enrolled In Hiv Care Clinic: A Qualitative Study

10.21203/rs.2.14292/v3 ◽

2020 ◽

Author(s):

Samuel Lawrent Mpinganjira ◽

Timothy Tchereni ◽

Andrews Gunda ◽

Victor Mwapasa

Keyword(s):

Qualitative Study ◽

Hiv Treatment ◽

Health Facilities ◽

Hiv Care ◽

Hiv Positive ◽

Long Distance ◽

Care Clinic ◽

Loss To Follow Up ◽

Factors Associated

Abstract Background In Malawi, loss to follow-up (LTFU) of HIV-positive pregnant and postpartum women on Option B+ regimen greatly contributes to sub-optimal retention, estimated to be 74% at 12 months postpartum. This threatens Malawi’s efforts to eliminate mother-to-child transmission of HIV. We investigated factors associated with LTFU among Mother-Infant Pairs. Methods We conducted a qualitative study, nested within the “Promoting Retention Among Infants and Mothers Effectively (PRIME)” study, a 3-arm cluster randomized trial assessing the effectiveness of strategies for improving retention of mother-infant pairs in HIV care in Salima and Mangochi districts, Malawi. From July to December 2016, we traced and interviewed 19 LTFU women. In addition, we interviewed 30 healthcare workers from health facilities where the LTFU women were receiving care. Recorded interviews were transcribed, translated and then analysed using deductive content analysis. Results The following reasons were reported as contributing to LTFU: lack of support from husbands or family members; long distance to health facilities; poverty; community-level stigma; ART side effects; perceived good health after taking ART and adoption of other alternative HIV treatment options. Conclusion Our study has found multiple factors at personal, family, community and health system levels, which contribute to poor retention of mother-infant pairs in HIV care. Key words PRIME, PMTCT, loss to follow up, mother-infant pairs, retention, Option B+

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Microbiologically Confirmed Tuberculosis: Factors Associated with Pre-Treatment Loss to Follow-Up, and Time to Treatment Initiation

PLoS ONE ◽

10.1371/journal.pone.0168659 ◽

2017 ◽

Vol 12 (1) ◽

pp. e0168659 ◽

Cited By ~ 8

Author(s):

Judith Mwansa-Kambafwile ◽

Boitumelo Maitshotlo ◽

Andrew Black

Keyword(s):

Treatment Initiation ◽

Time To Treatment ◽

Loss To Follow Up ◽

Factors Associated ◽

Pre Treatment ◽

Time To Treatment Initiation

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Analysis of loss to follow-up in 4099 multidrug-resistant pulmonary tuberculosis patients

European Respiratory Journal ◽

10.1183/13993003.00353-2018 ◽

2019 ◽

Vol 54 (1) ◽

pp. 1800353 ◽

Cited By ~ 1

Author(s):

Ian F. Walker ◽

Oumin Shi ◽

Joseph P. Hicks ◽

Helen Elsey ◽

Xiaolin Wei ◽

...

Keyword(s):

Risk Factors ◽

Adverse Event ◽

Treatment Success ◽

Multidrug Resistant ◽

Cox Proportional Hazards Model ◽

Serious Adverse Event ◽

Loss To Follow Up ◽

Factors Associated ◽

Mdr Tb

Loss to follow-up (LFU) of ≥2 consecutive months contributes to the poor levels of treatment success in multidrug-resistant tuberculosis (MDR-TB) reported by TB programmes. We explored the timing of when LFU occurs by month of MDR-TB treatment and identified patient-level risk factors associated with LFU.We analysed a dataset of individual MDR-TB patient data (4099 patients from 22 countries). We used Kaplan–Meier survival curves to plot time to LFU and a Cox proportional hazards model to explore the association of potential risk factors with LFU.Around one-sixth (n=702) of patients were recorded as LFU. Median (interquartile range) time to LFU was 7 (3–11) months. The majority of LFU occurred in the initial phase of treatment (75% in the first 11 months). Major risk factors associated with LFU were: age 36–50 years (HR 1.3, 95% CI 1.0–1.6; p=0.04) compared with age 0–25 years, being HIV positive (HR 1.8, 95% CI 1.2–2.7; p<0.01) compared with HIV negative, on an individualised treatment regimen (HR 0.7, 95% CI 0.6–1.0; p=0.03) compared with a standardised regimen and a recorded serious adverse event (HR 0.5, 95% CI 0.4–0.6; p<0.01) compared with no serious adverse event.Both patient- and regimen-related factors were associated with LFU, which may guide interventions to improve treatment adherence, particularly in the first 11 months.

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Compliance among infants exposed to hepatitis B virus in a post-vaccination serological testing program in four provinces in China

Infectious Diseases of Poverty ◽

10.1186/s40249-019-0568-y ◽

2019 ◽

Vol 8 (1) ◽

Cited By ~ 1

Author(s):

Hui Zheng ◽

Guo-Min Zhang ◽

Po-Lin Chan ◽

Fu-Zhen Wang ◽

Lance Everett Rodewald ◽

...

Keyword(s):

Hepatitis B Virus ◽

Hepatitis B ◽

Venous Blood ◽

Serological Testing ◽

Sample Collection ◽

Post Vaccination ◽

Loss To Follow Up ◽

Factors Associated ◽

B Virus

Abstract Background Mother to child transmission of hepatitis B virus (HBV) remains the most common form of HBV infection in China. Prevention of HBV vertical transmission involves timely administration of the complete hepatitis B vaccine (HepB) series and hepatitis B immunoglobulin. Post-vaccination serological testing (PVST) is utilized to determine an infant’s outcome after HBV exposure and completion of HepB series. We aim to determine the frequency of compliance with a PVST testing cascade for HBV infected mothers and analyze factors associated with infant lost to follow up (LTFU). Methods We conducted a retrospective cohort review of previously collected data in Fujian, Jiangxi, Zhejiang and Chongqing provinces in China from 1 June 2016–31 December 2017. The study population included all HBV-exposed infants and their mothers. SAS software was used for statistical analyses. Bivariate and multivariate regression analyses (presented in odds ratio [OR] with 95% confidence intervals [CI]) were used to compare the proportional differences of factors associated with PVST not being completed. Results Among enrolled 8474 target infants, 40% of them transferred out of the study provinces without further information and 4988 were eligible for PVST. We found 20% (994) of infants were not compliant with the testing cascade: 55% of LTFU occurred because parents refused venous blood sample collection or failure of sample collection in the field, 16% transferred out after 6 months of age, and 10% of families chose to have independent, confidential PVST completed without reporting results. High PVST noncompliance rates were more likely to be from Fujian (aOR = 17.0, 95% CI: 9.7–29.9), Zhejiang (aOR = 5.7, 95% CI: 3.2–10.1) and Jiangxi (aOR = 1.9, 95% CI: 1.0–3.4), and from HBV e antigen positive mother (aOR = 1.2, 95% CI: 1.1–1.4). Conclusions This study found that the LTFU rate reached 20% in PVST program, which was a significant problem. We recommend implementing a national electronic information system for tracking HBV at risk mother-infant pairs; encourage further research in developing a less invasive means of completing PVST, and take effective measures nationally to reduce HBV stigma. Without reducing the loss to follow up rate among infants eligible for PVST, elimination of vertical HBV transmission will be impossible.

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