LOGIN

International Epidemiology Databases to Evaluate AIDS

Home >> Publications >> Understanding reasons for and outcomes of patients lost to follow-up in antiretroviral therapy programs in Africa through a sampling-based approach.

Publication

Author(s):

Geng EH, Bangsberg DR, Musinguzi N, Emenyonu N, Bwana MB, Yiannoutsos CT, Glidden DV, Deeks SG, Martin JN.

Pub Title:

Understanding reasons for and outcomes of patients lost to follow-up in antiretroviral therapy programs in Africa through a sampling-based approach.

Pub Date:

Mar 31 2010

Pub Region(s):

East Africa

Journal Issue:

3

Page Number:
405-11

Journal:

Title: 
JAIDS- Journal of Acquired Immune Deficiency Syndromes
Link: 
http://journals.lww.com/jaids/pages/articleviewer.aspx?year=2010&issue=03010&article=00016&type=abstract

PubMed: 19745753
Pub PDF: PDF icon 19745753.pdf

Abstract
OBJECTIVES
: Losses to follow-up after initiation of antiretroviral therapy (ART) are common in Africa and are a considerable obstacle to understanding the effectiveness of nascent treatment programs. We sought to characterize, through a sampling-based approach, reasons for and outcomes of patients who become lost to follow-up.

DESIGN: Cohort study.

METHODS: We searched for and interviewed a representative sample of lost patients or close informants in the community to determine reasons for and outcomes among lost patients.

RESULTS: Three thousand six hundred twenty-eight HIV-infected adults initiated ART between January 1, 2004 and September 30, 2007 in Mbarara, Uganda. Eight hundred twenty-nine became lost to follow-up (cumulative incidence at 1, 2, and 3 years of 16%, 30%, and 39%). We sought a representative sample of 128 lost patients in the community and ascertained vital status in 111 (87%). Top reasons for loss included lack of transportation or money and work/child care responsibilities. Among the 111 lost patients who had their vital status ascertained through tracking, 32 deaths occurred (cumulative 1-year incidence 36%); mortality was highest shortly after the last clinic visit. Lower pre-ART CD4 T-cell count, older age, low blood pressure, and a central nervous system syndrome at the last clinic visit predicted deaths. Of patients directly interviewed, 83% were in care at another clinic and 71% were still using ART.

CONCLUSIONS: Sociostructural factors are the primary reasons for loss to follow-up. Outcomes among the lost are heterogeneous: both deaths and transfers to other clinics were common. Tracking a sample of lost patients is an efficient means for programs to understand site-specific reasons for and outcomes among patients lost to follow-up.

PMID: 19745753 [PubMed - indexed for MEDLINE]

PMCID: PMC3606953

 

The following websites provide guidelines and policies when citing from PubMed®: http://www.ncbi.nlm.nih.gov/books/NBK7243/
http://www.nlm.nih.gov/bsd/policy/cit_format.html

Citation:

Geng EH, Bangsberg DR, Musinguzi N, Emenyonu N, Bwana MB, Yiannoutsos CT, Glidden DV, Deeks SG, Martin JN. Understanding reasons for and outcomes of patients lost to follow-up in antiretroviral therapy programs in Africa through a sampling-based approach. J Acquir Immune Defic Syndr. 2010 Mar;53(3):405-11. doi: 10.1097/QAI.0b013e3181b843f0. PubMed PMID: 19745753; PubMed Central PMCID: PMC3606953.