title: Loss to follow-up in a community clinic in South Africa--roles of gender, pregnancy and CD4 count.
abstract: BACKGROUND
  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.
  
  
  OBJECTIVE
  To identify patient characteristics associated with LTFU 6 months after starting ART in a large community clinic.
  
  
  METHODS
  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.
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Division of General Medicine, Department of Medicine, Massachusetts General Hospital, Boston, Mass, USA.
authors.forename: Bingxia
authors.initials: B
authors.lastname: Wang
authors.forename: Elena
authors.initials: E
authors.lastname: Losina
authors.forename: Ruth
authors.initials: R
authors.lastname: Stark
authors.forename: Alison
authors.initials: A
authors.lastname: Munro
authors.forename: Rochelle P
authors.initials: RP
authors.lastname: Walensky
authors.forename: Marisa
authors.initials: M
authors.lastname: Wilke
authors.forename: Des
authors.initials: D
authors.lastname: Martin
authors.forename: Zhigang
authors.initials: Z
authors.lastname: Lu
authors.forename: Kenneth A
authors.initials: KA
authors.lastname: Freedberg
authors.forename: Robin
authors.initials: R
authors.lastname: Wood
mesh_terms: D000328:Adult; D044966:Anti-Retroviral Agents / Q000627:therapeutic use*; D018791:CD4 Lymphocyte Count; D003153:Community Health Services; D003266:Continuity of Patient Care / Q000458:organization & administration; D005260:Female; D015658:HIV Infections / Q000097:blood / Q000188:drug therapy* / Q000453:epidemiology; D006801:Humans; D008297:Male; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000097:blood / Q000188:drug therapy; D016016:Proportional Hazards Models; D013019:South Africa
chemical_list: D044966:Anti-Retroviral Agents