Profiles of HIV Care Disruptions Among Adult Patients Lost to Follow-up in Zambia

Purpose: To assess how the infrastructure improvements supported by the US Centers for Disease Control and Prevention (CDC) and the United States President’s Emergency Plan for AIDS Relief (PEPFAR) contributed to facility-level quarterly and annual new patient enrolment in HIV care and treatment and antiretroviral therapy (ART) uptake and retention in care.Methods: Aggregate quarterly and annual facility-based HIV care and treatment data from the CDC-managed PEPFAR Reporting Online and Management Information System database collected between 2005 and 2012 were analysed for the 11 rural and 32 urban facilities that met the eligibility criteria. Infrastructure improvements, including both renovations and new construction, occurred on different dates for the facilities; therefore, data were adjusted such that pre- and post-infrastructure improvements were aligned and date-time was ignored. The analysis calculated the mean (95% confidence interval) number of patients per facility who were (1) newly enrolled in HIV care, (2) patients initiated on ART, (3) patients retained in care, defined as alive and on ART, and (4) reasons for attrition, defined as transferred out, lost to follow-up, deceased or stopped ART.Results: The overall mean number of adult patients newly enrolled in HIV care clinics per quarter declined from 187.7 (151.4–223.9) to 135.2 (117.4–152.9) after infrastructure improvements but was not statistically significant (p = 0.20). However, the mean number of patients who were alive and remained on ART increased from 193.2 (145.3–241.1) to 273.2 (219.0–327.3) after improvements in both rural and urban facilities, although not significantly (p = 0.59). A similar picture was observed for overall paediatric enrolment and retention in care. Health facility-specific case studies show variations in new patient enrolment and retention in care between health facilities depending on the catchment area, population HIV prevalence and coverage of ART facilities. Regarding attrition, the mean number of adult patients lost to follow-up changed from 76.6 (20.8–132.3) to 139.4 (79.6–199.1) (p = 0.65) among rural facilities, while the mean number of children lost to follow-up increased significantly from 3.4 (0.5–6.3) to 8.7 (5.0–12.3) (p = 0.02) after improvements.Conclusion: Patient retention in care improved in HIV care and treatment facilities with infrastructure improvements. However, the overall number of patients newly enrolled and initiated on ART declined and attrition increased in facilities after improvements.

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Predictors of lost to follow up from antiretroviral therapy among adults in sub-Saharan Africa: a systematic review and meta-analysis

Infectious Diseases of Poverty ◽

10.1186/s40249-021-00822-7 ◽

2021 ◽

Vol 10 (1) ◽

Author(s):

Hafte Kahsay Kebede ◽

Lillian Mwanri ◽

Paul Ward ◽

Hailay Abrha Gesesew

Keyword(s):

Risk Factors ◽

Systematic Review ◽

Meta Analysis ◽

Sub Saharan Africa ◽

Hiv Care ◽

Care Services ◽

Validity Assessment ◽

Sub Saharan ◽

Lost To Follow Up

Abstract Background It is known that ‘drop out’ from human immunodeficiency virus (HIV) treatment, the so called lost-to-follow-up (LTFU) occurs to persons enrolled in HIV care services. However, in sub-Saharan Africa (SSA), the risk factors for the LTFU are not well understood. Methods We performed a systematic review and meta-analysis of risk factors for LTFU among adults living with HIV in SSA. A systematic search of literature using identified keywords and index terms was conducted across five databases: MEDLINE, PubMed, CINAHL, Scopus, and Web of Science. We included quantitative studies published in English from 2002 to 2019. The Joanna Briggs Institute Meta-Analysis of Statistics Assessment and Review Instrument (JBI-MAStARI) was used for methodological validity assessment and data extraction. Mantel Haenszel method using Revman-5 software was used for meta-analysis. We demonstrated the meta-analytic measure of association using pooled odds ratio (OR), 95% confidence interval (CI) and heterogeneity using I2 tests. Results Thirty studies met the search criteria and were included in the meta-analysis. Predictors of LTFU were: demographic factors including being: (i) a male (OR = 1.2, 95% CI 1.1–1.3, I2 = 59%), (ii) between 15 and 35 years old (OR = 1.3, 95% CI 1.1–1.3, I2 = 0%), (iii) unmarried (OR = 1.2, 95% CI 1.2–1.3, I2 = 21%), (iv) a rural dweller (OR = 2.01, 95% CI 1.5–2.7, I2 = 40%), (v) unemployed (OR = 1.2, 95% CI 1.04–1.4, I2 = 58%); (vi) diagnosed with behavioral factors including illegal drug use(OR = 13.5, 95% CI 7.2–25.5, I2 = 60%), alcohol drinking (OR = 2.9, 95% CI 1.9–4.4, I2 = 39%), and tobacco smoking (OR = 2.6, 95% CI 1.6–4.3, I2 = 74%); and clinical diagnosis of mental illness (OR = 3.4, 95% CI 2.2–5.2, I2 = 1%), bed ridden or ambulatory functional status (OR = 2.2, 95% CI 1.5–3.1, I2 = 74%), low CD4 count in the last visit (OR = 1.4, 95% CI 1.1–1.9, I2 = 75%), tuberculosis co-infection (OR = 1.2, 95% CI 1.02–1.4, I2 = 66%) and a history of opportunistic infections (OR = 2.5, 95% CI 1.7–2.8, I2 = 75%). Conclusions The current review identifies demographic, behavioral and clinical factors to be determinants of LTFU. We recommend strengthening of HIV care services in SSA targeting the aforementioned group of patients. Trial registration Protocol: the PROSPERO Registration Number is CRD42018114418

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Patients’ demographic and clinical characteristics and level of care associated with lost to follow-up and mortality in adult patients on first-line ART in Nigerian hospitals

Journal of the International AIDS Society ◽

10.7448/ias.15.2.17424 ◽

2012 ◽

Vol 15 (2) ◽

Cited By ~ 19

Author(s):

Solomon Odafe ◽

Ochanya Idoko ◽

Titilope Badru ◽

Bolatito Aiyenigba ◽

Chiho Suzuki ◽

...

Keyword(s):

Clinical Characteristics ◽

Adult Patients ◽

Level Of Care ◽

First Line ◽

Lost To Follow Up

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Retaining HIV-positive patients in HIV care: a personalised approach for those at risk of loss to follow-up at an inner city sexual health service

Sexual Health ◽

10.1071/sh17036 ◽

2018 ◽

Vol 15 (1) ◽

pp. 91

Author(s):

Loretta Healey ◽

Catherine C. O'Connor

Keyword(s):

Health Service ◽

Sexual Health ◽

Text Messages ◽

Hiv Care ◽

Hiv Positive ◽

Hiv Patients ◽

Loss To Follow Up ◽

Sexual Health Service ◽

Lost To Follow Up

In 2013 a personalised approach to follow-up of HIV patients who had withdrawn from HIV care was taken at RPA Sexual Health, a Sydney metropolitan sexual health service. HIV patients were telephoned, sent text messages, emailed and sent letters multiple times where applicable. With this intervention 20 of 23 people who had withdrawn from HIV care re-engaged. Since that time, active follow-up of all people diagnosed with HIV has resulted in only 2% of HIV patients at RPA Sexual Health being lost to follow-up.

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Real World Outcomes of Adult Patients with Diffuse Large B-Cell Lymphoma Receiving Fixed Dose Intravenous Rituximab in the Philippine General Hospital

Blood ◽

10.1182/blood-2021-152146 ◽

2021 ◽

Vol 138 (Supplement 1) ◽

pp. 5029-5029

Author(s):

Josephine Anne Lucero ◽

Danielle Benedict Sacdalan ◽

Cecilia Jimeno ◽

Ivy Mae S. Escasa

Keyword(s):

B Cell ◽

Board Of Directors ◽

B Cell Lymphoma ◽

Response Rates ◽

Adult Patients ◽

Fixed Dose ◽

Average Dose ◽

Advisory Committees ◽

Lost To Follow Up

Abstract Introduction. Diffuse large B-cell lymphoma (DLBCL) is the most frequent type of aggressive non-Hodgkin lymphoma (NHL). The backbone of therapy includes rituximab at a dose of 375 mg/m 2 however, the rationale for which is not explained in pharmacokinetic studies but has been the set dose for succeeding clinical trials. In limited-resource settings, standard regimen or fixed dose adaptations of certain cancer medicines are common. This study investigated the clinical profile and treatment outcomes of patients who received fixed dose intravenous (IV) rituximab of 500 mg per cycle for DLBCL. Methods. This study was a retrospective cohort conducted through review of records of adults diagnosed with DLBCL given fixed dose IV rituximab of 500mg at the University of the Philippines - Philippine General Hospital from January 1, 2015 to December 31, 2019. Clinical characteristics, stage, international prognostication index (IPI), body surface area dosing, response assessment, and overall survival (OS) and progression-free survival (PFS) were recorded. The computed sample size was 110 patients however, all patients within the period of observation were included. Results. One hundred thirty-two adult patients with DLBCL were identified of which, 77 received a rituximab-based regimen, and 71 received fixed dose IV rituximab of 500mg and were included in the study. Table 1 summarizes the baseline demographic and clinical characteristics of the participants. The mean age was 46 years old with a slight male predominance. Eighty percent of patients received a dose below 350 mg/m 2. Fifty-one percent of patients had bulky and advanced stage of disease. Thirty-nine percent of patients presented with B symptoms. Eighty-two percent had one or no comorbidities on consult. Sixty-six percent had a low-risk IPI of 0 or 1, 30% with a low-intermediate risk IPI of 2, and 4% with a high-intermediate risk IPI of 3. Ninety percent of patients received rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone (RCHOP). The mean number of doses of rituximab received was 6 and patients received treatment at a mean interval of 1 month from diagnosis. Notably, only three patients underwent immunohistochemistry studies to determine the subtype of DLBCL. All three were found to have activated B cell as the cell of origin. Table 2 summarizes the distribution of outcomes in relation to average dose received. Of the original 71 who received fixed-dose Rituximab, 25 patients had no documentation of objective response assessment. Thirty or 43% showed complete response and 20% showed progressive disease. Complete response was documented across dose ranges from 250 to 400 mg/m 2 however, 77% of complete responders received a dose lower than 350 mg/m 2. Conversely, 79% of patients with progressive disease received a dose lower than 350 mg/m 2. There were no noted significant associations between these outcomes and the average dose range of rituximab received based on Fisher's exact test. This finding is also illustrated in Figure 1, which is a boxed plot diagram of the range of dose received across clinical outcomes. Because of the limited number of patients and sparse distribution of outcomes, a Cox proportional hazard model could not be made. Table 3 shows the distribution of characteristics across clinical outcomes. Age and follow-up time were significantly different across the three groups. No difference was found for the other clinical variables. A Kaplan-Meier survival plot could not be constructed due to the high lost to follow-up rate, with 66% of patients being lost to follow-up at time of analysis. Discussion and Conclusions. The study identified the high use of fixed dose IV rituximab in our hospital rather than the recommended dosing of 375 mg/m 2. These patients showed comparable initial response rates of fixed dose rituximab in adult patients with DLBCL compared to response rates from previous RCTs, however long-term response rates were not evaluable. The study was not able to demonstrate the durability of response, given the lack of data and high lost to follow-up rate. At the time of analysis, the use of subcutaneous (SC) rituximab has not progressed in the treatment center, and the prohibitive cost of both IV and SC rituximab has affected its optimal use. Pharmacokinetic modeling and longer-term cohorts of fixed-dose studies may provide more robust data to support the use of fixed-dose treatment strategies. Figure 1 Figure 1. Disclosures Jimeno: Novo Nordisk: Membership on an entity's Board of Directors or advisory committees, Speakers Bureau; Merck Sharp & Dohme: Membership on an entity's Board of Directors or advisory committees, Speakers Bureau; Johnson and Johnson: Membership on an entity's Board of Directors or advisory committees, Speakers Bureau; Astrazeneca: Speakers Bureau; Sanofi: Speakers Bureau; Servier: Speakers Bureau; Pfizer: Speakers Bureau. Escasa: Janssen: Membership on an entity's Board of Directors or advisory committees, Other: lecturer, registration and travel grants; Novartis: Other: lecturer, registration and travel grants; Roche: Other: lecturer; Sun Pharma: Other: lecturer, registration and travel grants.

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The cost and effect of expanding a Patient Tracer programme to identify and return patients loss to follow up at a large HIV Clinic in Trinidad

10.21203/rs.3.rs-41913/v1 ◽

2020 ◽

Author(s):

R. Jeffrey Edwards ◽

Nyla Lyons ◽

Wendy Samaroo-Francis ◽

Leon-Omari Lavia ◽

Isshad John ◽

...

Keyword(s):

Viral Suppression ◽

Hiv Care ◽

Loss To Follow Up ◽

Treatment Clinic ◽

The Status ◽

Clinic Medical ◽

The Cost ◽

Lost To Follow Up ◽

Over Time

Abstract Background: Patients who default from HIV care are usually poorly adherent to antiretroviral treatment which results in suboptimal viral suppression. The study evaluated the effect and cost of expanding an intervention using two Patient Tracers to track and return to care patients lost to follow up at a large HIV Clinic in Trinidad.Methods: Two Social Workers were trained as Patient Tracers and hired initially for 6 months (April –September 2017), then extended to 15 months (April 2017 – June 2018) to call patients who were lost to follow up for 30 days or more during the period July 2016 – May 2018 at the HIV Clinic Medical Research Foundation of Trinidad and Tobago. Both the outcomes of the intervention, and costs were assessed over time. Results: Over the 15 month period, of the of 2,473 patients who missed their scheduled visits for one month or more, 261 (10.6%) patients were no longer in active care - 89 patients dead, 65 migrated, 55 hospitalized, 33 transferred to another treatment clinic and 19 incarcerated. Of the remaining 2,212 patients eligible for tracing, 1,794 (81.1%) patients were returned to care at an average cost of $38.09 USD per patient returned to care as compared to 589 of 866 (68%) patients returned to care over the 6 month period (p < 0.001) at an estimated cost of $47.72 USD per patient returned to care (p<0.001). Of the 1,794 patients returned to care, 1,686 (94%) were re-initiated/started on anti-retroviral therapy and 72.7% of these were virally suppressed (viral load <1,000 copies/ml) as of December 2018.Conclusions: Patient Tracing is a feasible and effective intervention to identify and resolve the status of patients who are loss to follow up to bring these patients back into care with the aim of achieving viral suppression on antiretroviral therapy. Over time the effect of costs of patients returned to care demonstrated greater yields making patient tracing a sustainable intervention for programmes to identify and return patients to care.

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1319. Events of Disengagement from HIV care and Subsequent Reengagement in a Kenyan Pastoralist Community: Frequency, Determinants, and Patient Views

Open Forum Infectious Diseases ◽

10.1093/ofid/ofz360.1182 ◽

2019 ◽

Vol 6 (Supplement_2) ◽

pp. S476-S477

Author(s):

Paul Otieno Yonga ◽

Stephen Kiplimo Kalya ◽

Lutgarde Lynen ◽

Tom Decroo

Keyword(s):

Antiretroviral Therapy ◽

Hiv Transmission ◽

Hospital Admissions ◽

Hiv Care ◽

Engagement In Care ◽

Work Related ◽

Medication Side ◽

Competing Priorities ◽

Lost To Follow Up

Abstract Background Regular follow-up HIV-infected patients on antiretroviral therapy (ART) is vital to ensure viral suppression, thus reducing HIV transmission, and HIV-related morbidity and mortality. However, some patients have been reported to have events of disengagement from care with subsequent re-engagement in care, though knowledge on the magnitude and determinants of this phenomenon, particularly in pastoralist communities is scarce. Methods A mixed-methods study was carried out among HIV-infected patients on antiretroviral therapy (ART) follow-up between January 2014 and June 2017 at the Baringo County Referral Hospital, Kabarnet, Kenya. Records on their clinic attendance and laboratory follow-up were extracted, and those noted to have a recent event of disengagement from care who later re-engaged in care, were then purposively sampled for in-depth interviews. Results 342 patient records were analyzed, of which 48% (166/342) of the patients were noted to be active at the end of the study period, with 63.3% (105/166) of them noted to have one or more events of disengagement from care. Female patients, patients with baseline CD4 counts ≥200 cells/mm3, and patients with a low WHO stage category (I and II) were more likely to return to care after an experience of disengagement from HIV care (P < 0.05). Eight interviewee transcripts showed the following reported reasons for disengagement in care: long distances, stigma, work-related problems, medication side effects, competing priorities, perceived recovery of the health status, medication fatigue, and not being informed of their clinic return dates. Motivators for re-engagement in care included hospital admissions, fear of getting sick like their spouse, and phone reminders. Conclusion A vast majority of patients currently active in care experienced multiple events of disengagement from care. Thus, early identification of those who disengage from care is recommended, before they become lost to follow-up. Disclosures All authors: No reported disclosures.

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The expansion of a patient tracer programme to identify and return patients loss to follow up at a large HIV clinic in Trinidad

AIDS Research and Therapy ◽

10.1186/s12981-021-00341-3 ◽

2021 ◽

Vol 18 (1) ◽

Author(s):

R. Jeffrey Edwards ◽

Nyla Lyons ◽

Wendy Samaroo-Francis ◽

Leon-Omari Lavia ◽

Isshad John ◽

...

Keyword(s):

Viral Suppression ◽

Retention In Care ◽

Hiv Care ◽

Loss To Follow Up ◽

Targeted Interventions ◽

The Status ◽

Care Models ◽

Clinic Medical ◽

Lost To Follow Up

Abstract Background Patients who default from HIV care are usually poorly adherent to antiretroviral treatment which results in suboptimal viral suppression. The study assessed the outcomes of retention in care and viral suppression by expansion of an intervention using two patient tracers to track patients lost to follow up at a large HIV clinic in Trinidad. Methods Two Social Workers were trained as patient tracers and hired for 15 months (April 2017–June 2018) to call patients who were lost to follow up for 30 days or more during the period July 2016–May 2018 at the HIV clinic Medical Research Foundation of Trinidad and Tobago. Results Over the 15-month period, of the of 2473 patients who missed their scheduled visits for 1 month or more, 261 (10.6%) patients were no longer in active care—89 patients dead, 65 migrated, 55 hospitalized, 33 transferred to another treatment clinic and 19 incarcerated. Of the remaining 2212 patients eligible for tracing, 1869 (84.5%) patients were returned to care, 1278 (68.6%) were virally unsuppressed (viral load > 200 copies/ml) and 1727 (92.4%) were re-initiated on ART. Twelve months after their return, 1341 (71.7%) of 1869 patients were retained in care and 1154 (86.1%) of these were virally suppressed. Multivariate analysis using logistic regression showed that persons were more likely to be virally suppressed if they were employed (OR, 1.39; 95% CI 1.07–1.80), if they had baseline CD4 counts < 200 cells/mm3 (OR, 1.71; 95% CI 1.26–2.32) and if they were retained in care at 12 months (OR, 2.48; 95% CI 1.90–3.24). Persons initiated on ART for 4–6 years (OR, 3.09; 95% CI 1.13–8.48,), 7–9 years (OR, 3.97; 95% CI 1.39–11.31), > 10 years (OR, 5.99; 95% CI 1.74–20.64 were more likely to be retained in care. Conclusions Patient Tracing is a feasible intervention to identify and resolve the status of patients who are loss to follow up and targeted interventions such as differentiated care models may be important to improve retention in care.

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Factors associated with retention in HIV care at Sediba Hope Medical Centre

Southern African Journal of HIV Medicine ◽

10.4102/sajhivmed.v16i1.347 ◽

2015 ◽

Vol 16 (1) ◽

Cited By ~ 3

Author(s):

Nishana Ramdas ◽

Johanna C. Meyer ◽

David Cameron

Keyword(s):

Support Group ◽

Retention In Care ◽

Electronic System ◽

Hiv Care ◽

Work Related ◽

Retention In Hiv Care ◽

Close Proximity ◽

Related Stress ◽

Lost To Follow Up

Background: Lost to follow-up (LTFU) is a major challenge that hinders the success of antiretroviral treatment (ART).Objective: To identify factors conducted to a low LTFU rate.Methods: We conducted a two-part descriptive and quantitative study. Part 1 comprised interviews with clinic staff to determine their perspectives on LTFU and to establish the clinic’s follow-up procedures for patients on ART. Part 2 of the study was a retrospective review of clinic and patient records. LTFU patients were identified and those with contact details were contacted for telephonic interview to determine if they were still on ART and/or their reasons for becoming LTFU.Results: A low LTFU rate (7.9%; N = 683) was identified. Work-related stress, and lack of transport and funds were reported reasons for LTFU. Monthly visits, non-adherent defaulters and LTFU patients were tracked by an electronic system (SOZO). Factors contributing to high rates of retention in care were: location of the clinic in the inner city, thus in close proximity to patients’ homes or work; clinic operating on Saturdays, which was convenient for patients who could not attend during the week; an appointment/booking system that was in place and strictly adhered to; a reminder SMS being sent out the day before an appointment; individual counselling sessions at each visit and referrals where necessary; and a stable staff complement and support group at the clinic.Conclusion: Achieving a low LTFU rate is possible by having a patient-centred approach and monitoring systems in place.

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