+ Site Statistics
+ Search Articles
+ PDF Full Text Service
How our service works
Request PDF Full Text
+ Follow Us
Follow on Facebook
Follow on Twitter
Follow on LinkedIn
+ Subscribe to Site Feeds
Most Shared
PDF Full Text
+ Translate
+ Recently Requested

Factors associated with loss to clinic among HIV patients not yet known to be eligible for antiretroviral therapy (ART) in Mozambique

Factors associated with loss to clinic among HIV patients not yet known to be eligible for antiretroviral therapy (ART) in Mozambique

Journal of the International Aids Society 16: 18490

Retention in HIV care prior to ART initiation is generally felt to be suboptimal, but has not been well-characterized. We examined data on 37,352 adult pre-ART patients (ART ineligible or unknown eligibility) who enrolled in care during 2005-2008 with >1 clinical visit at 23 clinics in Mozambique. We defined loss to clinic (LTC) as >12 months since the last visit among those not known to have died/transferred. Cox proportional-hazards models were used to examine factors associated with LTC, accounting for clustering within sites. Of 37,352 pre-ART patients, 61% had a CD4 count within three months of enrolment (median CD4: 452, IQR: 345-611). 17,598 (47.1%) were ART ineligible and 19,754 (52.9%) were of unknown eligibility status at enrolment because of missing information on CD4 count and/or WHO stage. Kaplan-Meier estimates for LTC at 12 months were 41% (95% CI: 40.2-41.8) and 48% (95% CI: 47.2-48.8), respectively. Factors associated with LTC among ART ineligible patients included male sex (AHR(men_vs_non-pregnant women): 1.5; 95% CI: 1.4-1.6) and being pregnant at enrolment (AHR(pregnant_vs_non-pregnant women): 1.3; 95% CI: 1.1-1.5). Older age, more education, higher weight and more advanced WHO stage at enrolment were independently associated with lower risks of LTC. Similar findings were observed among patients whose ART eligibility status was unknown at enrolment. Substantial LTC occurred prior to ART initiation among patients not yet known to be eligible for ART, including nearly half of patients without documented ART eligibility assessment. Interventions are needed to target pre-ART patients who may be at higher risk for LTC, including pregnant women and patients with less advanced HIV disease.

Please choose payment method:

(PDF emailed within 0-6 h: $19.90)

Accession: 053193596

Download citation: RISBibTeXText

PMID: 23755857

DOI: 10.7448/ias.16.1.18490

Related references

Pre-treatment mortality and loss-to-follow-up in HIV-1, HIV-2 and HIV-1/HIV-2 dually infected patients eligible for antiretroviral therapy in The Gambia, West Africa. Aids Research and Therapy 8(1): 24, 2011

Who starts? Factors associated with starting antiretroviral therapy among eligible patients in two, public HIV clinics in Lilongwe, Malawi. Plos one 7(11): E50871, 2012

Predictors of delayed antiretroviral therapy initiation, mortality, and loss to followup in HIV infected patients eligible for HIV treatment: data from an HIV cohort study in India. Biomed Research International 2013: 849042, 2013

Mortality among antiretroviral-eligible patients in an urban public clinic. Journal of Acquired Immune Deficiency Syndromes 57(4): 297-300, 2011

Two-year death and loss to follow-up outcomes by source of referral to HIV care for HIV-infected patients initiating antiretroviral therapy in rural Mozambique. Aids Research and Human Retroviruses 31(2): 198-207, 2015

Mortality and Loss to Follow up Before Initiation of Antiretroviral Therapy Among HIV-Infected Children Eligible for HIV Treatment. Infectious Disease Reports 6(2): 5167, 2014

Mortality and loss to programme before antiretroviral therapy among HIV-infected children eligible for treatment in The Gambia, West Africa. Aids Research and Therapy 9(1): 28, 2012

Patient loss to follow-up before antiretroviral therapy initiation in rural Mozambique. Aids and Behavior 19(4): 666-678, 2015

Risk factors for mortality among malnourished HIV-infected adults eligible for antiretroviral therapy. Bmc Infectious Diseases 16(1): 562, 2016

Factors associated with sustained virologic suppression in patients receiving antiretroviral therapy in an urban HIV care clinic. Aids Patient Care and Stds 19(12): 785-793, 2005

Factors associated with the use of highly active antiretroviral therapy in patients newly entering care in an urban clinic. Journal of Acquired Immune Deficiency Syndromes 32(4): 399-405, 2003

Factors associated with late antiretroviral therapy initiation among adults in Mozambique. Plos one 7(5): E37125, 2012

Loss of HIV-infected patients on potent antiretroviral therapy programs in Togo: risk factors and the fate of these patients. Pan African Medical Journal 15: 35, 2013

Finding patients eligible for antiretroviral therapy using TB services as entry point for HIV treatment. Tropical Medicine and International Health 11(10): 1567-1575, 2006

Bioengineered human pseudoislets form efficiently from donated tissue, compare favourably with native islets in vitro and restore normoglycaemia in mice. Diabetologia 61(9): 2016-2029, 2018