title: Characteristics and outcomes of adult patients lost to follow-up at an antiretroviral treatment clinic in johannesburg, South Africa.
abstract: BACKGROUND
  A significant proportion of those initiating antiretroviral treatment (ART) for HIV infection are lost to follow-up. Causes for discontinuing ART follow-up in resource-limited settings are not well understood.
  
  
  METHODS
  A retrospective analysis was conducted of all adult patients receiving ART at an urban public clinic in Johannesburg, South Africa between April 2004 and June 2005. Patients discontinuing follow-up for at least 6 weeks were identified and further studied, and causes for treatment default were tabulated.
  
  
  RESULTS
  Of 1631 adult patients studied, 267 (16.4%) discontinued follow-up during the study period. Gender, ethnicity, and age were not predictive of loss to follow-up. Of those discontinuing follow-up, 173 (64.8%) were successfully traced. Death accounted for 48% (n = 83) of those traced. Characteristics associated with death were older age at ART initiation (P = 0.022), lower baseline CD4 cell count (P = 0.0073), higher initial HIV RNA load (P = 0.024), and loss of weight on ART (P = 0.033). Date of death was known for 71% (n = 59) of patients traced deceased, of whom 83% (n = 49) had died within 30 days of active ART. Common nonmortality losses included relocation or clinic transfer (25.4%) and hospitalization or illness not resulting in death (10.4%). Few cited financial difficulty or medication toxicity as reasons for discontinuing follow-up.
  
  
  CONCLUSIONS
  Nearly 1 in 6 patients receiving ART in a resource-constrained setting had discontinued follow-up over a 15-month period. Early mortality was high, especially in those with profound immunosuppression. Improving access to care and streamlining patient tracking may improve ART outcomes.
authors.affiliation: Washington University School of Medicine, St. Louis, MO, USA. dalalr@msnotes.wustl.edu
authors.forename: Rishikesh P
authors.initials: RP
authors.lastname: Dalal
authors.forename: Catherine
authors.initials: C
authors.lastname: Macphail
authors.forename: Mmabatho
authors.initials: M
authors.lastname: Mqhayi
authors.forename: Jeff
authors.initials: J
authors.lastname: Wing
authors.forename: Charles
authors.initials: C
authors.lastname: Feldman
authors.forename: Matthew F
authors.initials: MF
authors.lastname: Chersich
authors.forename: Willem D F
authors.initials: WD
authors.lastname: Venter
mesh_terms: D000328:Adult; D019380:Anti-HIV Agents / Q000627:therapeutic use*; D005260:Female; D005500:Follow-Up Studies; D015658:HIV Infections / Q000188:drug therapy*; D006801:Humans; D008297:Male; D010349:Patient Compliance; D012189:Retrospective Studies; D013019:South Africa
chemical_list: D019380:Anti-HIV Agents