Loss to follow-up in a community clinic in South Africa--roles of gender, pregnancy and CD4 count
Wang, B.; Losina, E.; Stark, R.; Munro, A.; Walensky, R.P.; Wilke, M.; Martin, D.; Lu, Z.; Freedberg, K.A.; Wood, R.
South African Medical Journal 101(4): 253-257
2011
ISSN/ISBN: 0256-9574 PMID: 21786730 DOI: 10.7196/samj.4078Document Number: 220046
Faith-based organisations have expanded antiretroviral therapy (ART) in community clinics across South Africa. Loss to follow-up (LTFU), however, limits the potential individual and population treatment benefits and optimal care. To identify patient characteristics associated with LTFU 6 months after starting ART in a large community clinic. Patients initiating ART between April 2004 and October 2006 in one South African Catholic Bishops' Conference HIV treatment clinic who had at least one follow-up visit were included and routinely monitored every 6 months after ART initiation. Standardised instruments were used to collect data. Rates of LTFU over time were estimated by the Kaplan-Meier method. The Cox proportional hazard regression examined the impact of age, baseline CD4 count, baseline HIV RNA, gender and pregnancy status on LTFU. Data from 925 patients (age >14 years, median age 36 years, 70% female, of whom 16% were pregnant) were included: 51 (6%) were lost to follow-up 6 months after ART initiation. Younger age (< or = 30 years) (hazard ratio (HR) 2.14, 95% confidence interval (CI) 1.05 - 4.38) and pregnancy for women (HR 3.75, 95% CI 1.53 - 9.16) were significantly associated with higher LTFU rates. When stratified by baseline CD4 count, gender and pregnancy status, pregnant women with lower baseline CD4 counts (< or = 200 cells/microl) had 6.06 times the hazard (95% CI 2.20 - 16.71) of LTFU at 6 months compared with men. HIV-infected pregnant women initiating ART were significantly more likely to be lost to follow-up in a community clinic in South Africa. Urgent interventions to successfully retain pregnant women in care are needed.