Predictors of Loss to Followâup Among HIVâinfected Patients in a Rural SouthâEastern Nigeria Hospital: A 5âyear Retrospective Cohort Study
2015
Background: Patient attrition has been a challenge in managing HIV programs in resourceâlimited settings. Aim: This study reviews the predictors of loss to followâup (LTFU) in our hospital and suggests the best practices for dealing with the issue. Subjects and Methods: A 5âyear retrospective cohort study of 1256 HIVâinfected patients. Baseline CD4 counts, age, gender, year of enrolment, and antiretroviral therapy combination regimen were considered in this study. Kaplan–Meier models were used to estimate the univariate timeâtoâLTFU and Cox proportional hazards models to identify the multivariate predictors of LTFU. Results: Twentyâfour percent (23.9% [301/1256]) of patients were lost to followâup. Baseline CD4 count, year of enrolment, and drug combination were significant predictors of LTFU. Patients enrolled earlier (2008/2009) were twice as likely to be LTFU compared with those enrolled later (2010–2013). Gender and age did not significantly predict LTFU nor confound other predictors. Conclusion: The program showed higher LTFU rates than most studies in Nigeria and Africa, maybe due to difficulties with the access to the hospital and possible treatment fatigue. This study recommends the provision of transportation subsidies and proactive patient followâup with “peerâtracking” to reduce LTFU among HIV infected patients, especially in resourceâlimited settings.
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