Time-Dependent Predictors of Loss to Follow-Up in a Large HIV Treatment Cohort in Nigeria
Meloni, Seema Thakore
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CitationMeloni, Seema Thakore, Charlotte Chang, Beth Chaplin, Holly Rawizza, Oluwatoyin Jolayemi, Bolanle Banigbe, Prosper Okonkwo, and Phyllis Kanki. 2014. “Time-Dependent Predictors of Loss to Follow-Up in a Large HIV Treatment Cohort in Nigeria.” Open Forum Infectious Diseases 1 (2): ofu055. doi:10.1093/ofid/ofu055. http://dx.doi.org/10.1093/ofid/ofu055.
AbstractBackground: Most evaluations of loss to follow-up (LTFU) in human immunodeficiency virus (HIV) treatment programs focus on baseline predictors, prior to antiretroviral therapy (ART) initiation. As risk of LTFU is a continuous issue, the aim of this evaluation was to augment existing information with further examination of time-dependent predictors of loss. Methods: This was a retrospective evaluation of data collected between 2004 and 2012 by the Harvard School of Public Health and the AIDS Prevention Initiative in Nigeria as part of PEPFAR-funded program in Nigeria. We used multivariate modeling methods to examine associations between CD4+ cell counts, viral load, and early adherence patterns with LTFU, defined as no refills collected for at least 2 months since the last scheduled appointment. Results: Of 51 953 patients initiated on ART between 2004 and 2011, 14 626 (28%) were LTFU by 2012. Factors associated with increased risk for LTFU were young age, having nonincome-generating occupations or no education, being unmarried, World Health Organization (WHO) stage, having a detectable viral load, and lower CD4+ cell counts. In a subset analysis, adherence patterns during the first 3 months of ART were associated with risk of LTFU by month 12. Conclusions: In settings with limited resources, early adherence patterns, as well as CD4+ cell counts and unsuppressed viral load, at any time point in treatment are predictive of loss and serve as effective markers for developing targeted interventions to reduce rates of attrition.
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