title: Medication possession ratio: predicting and decreasing loss to follow-up in antiretroviral treatment programs in Côte d'Ivoire.
abstract: BACKGROUND
  In antiretroviral therapy (ART) programs, decreasing loss to follow up (LTFU) is a major priority.
  
  
  METHODS
  We conducted a prospective study in Abidjan. Adults who started ART between June 2005 and May 2008 and were still in care 6 months later had monthly visits, biannual CD4 counts, computerized data collection and home visits (routine follow-up). A subset of patients also had biannual plasma HIV-1 RNA measurements, with a physician and a research assistant hired to pay particular attention to their visits (enhanced follow-up). We analyzed the association between 18-month outcomes and pre-ART characteristics, medication possession ratio (MPR) and type of follow-up. Patients were LTFU if their last visit was before month-18 and they had not returned to care by month-24.
  
  
  RESULTS
  2,074 patients started ART, of whom 1,636 (79%) were still in care at month-6. The routine (n = 999) and enhanced (n = 637) groups had similar baseline characteristics. From month-6 to month-18, they had similar death rates (routine 3.6%, enhanced 3.9%, P = 0.74), but the enhanced group had significantly less LTFU (routine 11.3%, enhanced 5.8%, P < 0.001). In multivariate analysis, the risk of LTFU from month-6 to month-18 was 46% lower with enhanced follow-up, 56% higher in patients living outside the centre area, and 4.0 fold higher in patients with a low MPR (<80%) between ART initiation and month-6.
  
  
  CONCLUSIONS
  In patients still in care at 6 months, a low MPR in the first 6 months was strongly associated with further LTFU. Simple follow-up enhancement halved the LTFU rate in the following year.
authors.affiliation: PACCI-CI Program, Abidjan, Côte d'Ivoire.
authors.forename: Eugène
authors.initials: E
authors.lastname: Messou
authors.forename: Martial
authors.initials: M
authors.lastname: Kouakou
authors.forename: Delphine
authors.initials: D
authors.lastname: Gabillard
authors.forename: Patrice
authors.initials: P
authors.lastname: Gouessé
authors.forename: Mamadou
authors.initials: M
authors.lastname: Koné
authors.forename: Amah
authors.initials: A
authors.lastname: Tchehy
authors.forename: Elena
authors.initials: E
authors.lastname: Losina
authors.forename: Kenneth A
authors.initials: KA
authors.lastname: Freedberg
authors.forename: Thérèse N'
authors.initials: TN
authors.lastname: Dri-Yoman
authors.forename: Amani
authors.initials: A
authors.lastname: Anzian
authors.forename: Siaka
authors.initials: S
authors.lastname: Toure
authors.forename: Xavier
authors.initials: X
authors.lastname: Anglaret
mesh_terms: D000328:Adult; D019380:Anti-HIV Agents / Q000627:therapeutic use*; D007560:Cote d'Ivoire; D005260:Female; D005500:Follow-Up Studies; D015658:HIV Infections / Q000188:drug therapy*; D006801:Humans; D008297:Male; D011446:Prospective Studies
chemical_list: D019380:Anti-HIV Agents