TY - JOUR
T1 - Factors associated with loss to clinic among HIV patients not yet known to be eligible for antiretroviral therapy (ART) in Mozambique
AU - Pati, Rituparna
AU - Lahuerta, Maria
AU - Elul, Batya
AU - Okamura, Mie
AU - Alvim, Maria Fernanda
AU - Schackman, Bruce
AU - Bang, Heejung
AU - Fernandes, Rufino
AU - Assan, Americo
AU - Lima, Josue
AU - Nash, Denis
PY - 2013/6/10
Y1 - 2013/6/10
N2 - Introduction: Retention in HIV care prior to ART initiation is generally felt to be suboptimal, but has not been well-characterized. Methods: 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. Results: 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 (AHRmen-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. Conclusions: 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.
AB - Introduction: Retention in HIV care prior to ART initiation is generally felt to be suboptimal, but has not been well-characterized. Methods: 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. Results: 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 (AHRmen-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. Conclusions: 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.
KW - ART eligibility
KW - Loss to care
KW - Mozambique
KW - Operations research
KW - PEPFAR
KW - Pre-ART
KW - Pregnancy
KW - Retention
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U2 - 10.7448/IAS.16.1.18490
DO - 10.7448/IAS.16.1.18490
M3 - Article
C2 - 23755857
AN - SCOPUS:84886795258
VL - 16
JO - Journal of the International AIDS Society
JF - Journal of the International AIDS Society
SN - 1758-2652
M1 - 18490
ER -