title: Early loss to follow up after enrolment in pre-ART care at a large public clinic in Johannesburg, South Africa.
abstract: OBJECTIVE
  To estimate loss to follow up (LTFU) between initial enrollment and the first scheduled return medical visit of a pre-antiretroviral therapy (ART) care program for patients not eligible for ART.
  
  
  METHODS
  The study was conducted at a public-sector HIV clinic in Johannesburg. We reviewed records of all patients newly enrolled in the pre-ART care program and not yet eligible for ART between January 2007 and February 2008. Crude proportions of patients completing their first return medical visit stratified by patient characteristics were calculated. A modified-Poisson approach was used to estimate directly relative risks of returning for their first return medical visit within 1 year adjusting for patient characteristics as potential confounders.
  
  
  RESULTS
  A total of 356 patients were identified. Two-thirds had a CD4 count > 350 cells/microl (median [IQR] CD4 = 458 [394, 585]) and were scheduled to return in 6 months for a first medical visit. Seventy-four percent of these patients did not return within one year for this visit. The remaining 36% of all patients had a baseline CD4 count 251-350 cells/microl and were scheduled to return in 3 months. Only 6% of these patients returned within 4 months; 41% returned within one year. Relative risks were positively associated with a patient being employed and negatively associated with the baseline CD4 count.
  
  
  CONCLUSIONS
  Given the high rate of LTFU immediately after enrolling in pre-ART care, it is clear that care programs are not expediting the timely initiation of ART. Significantly improved adherence to pre-ART care and monitoring for patients not yet eligible for ART is required for South Africa to achieve its AIDS strategy goals and reduce the problem of late presentation and initiation of ART.
authors.affiliation: Center for Global Health and Development, Boston University School of Public Health, Boston, MA 02118, USA. blarson@bu.edu
authors.forename: Bruce A
authors.initials: BA
authors.lastname: Larson
authors.forename: Alana
authors.initials: A
authors.lastname: Brennan
authors.forename: Lynne
authors.initials: L
authors.lastname: McNamara
authors.forename: Lawrence
authors.initials: L
authors.lastname: Long
authors.forename: Sydney
authors.initials: S
authors.lastname: Rosen
authors.forename: Ian
authors.initials: I
authors.lastname: Sanne
authors.forename: Matthew P
authors.initials: MP
authors.lastname: Fox
mesh_terms: D000328:Adult; D023241:Antiretroviral Therapy, Highly Active; D018791:CD4 Lymphocyte Count; D005260:Female; D005500:Follow-Up Studies; D015658:HIV Infections / Q000276:immunology / Q000523:psychology / Q000628:therapy*; D006801:Humans; D008134:Long-Term Care; D059012:Lost to Follow-Up; D008297:Male; D010349:Patient Compliance / Q000706:statistics & numerical data; D010352:Patient Dropouts / Q000706:statistics & numerical data*; D015397:Program Evaluation; D013019:South Africa