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CROI 2013: A closer look at HIV-positives lost to follow-up

Engagement and retention in care are linked to improved HIV outcomes, but few studies have described the characteristics of clients who are lost to follow-up (LTF) in resource limited settings, especially those who have not yet initiated antiretroviral therapy. Chloe Teasdale, from Columbia University (and recipient of a young investigator award), reported on retention in care and mortality using data from 41 health facilities in Rwanda. The study used routinely collected patient-level (de-identified) variables on 31,027 adults >15 years enrolled in care between 2005 and 2010; outcomes were examined using observations from pre-ART care and after ART initiation.

LTF prior to ART initiation was 11.2% (95% CI 10.9-11.6%) at two years after enrollment. Mortality prior to ART initiation was 2.7% (2.5-2.8) at 2 years after enrollment. Pre-ART LTF was associated with male gender, being single and younger age, as well as better health status as measured by CD4 count and WHO stage, whereas mortality was associated with male gender and more advanced age and disease status. For patients on ART, LTF was 4.4% (4.4-4.5%) and mortality was 6.3% (6.2-6.4%) at 2 years after ART initiation. LTF in ART patients was associated with male sex, being single, younger age and healthier status at ART initiation.

A key finding in this study is that the highest LTF was seen among healthier persons who had not yet initiated ART. Improving HIV outcomes in resource-limited settings may require greater attention and resources directed towards this group.

Teasdale C, Mugisha V, Wang C, Nuwagaba-Biribonwoha H, Tayebwa E, Ingabire E, Ingabire P, Lahuerta M, Sahabo R, Twyman P, Abrams E. Determinants of mortality and loss to follow-up among adult patients in pre-ART care and on ART in Rwanda. Presented March 5, 2013 at the 20th CROI, Atlanta, GA. Oral Abstract #92.

Source: Reporting from Atlanta for PRN News: Anita Radix MD, MPH