title: Early loss to follow-up of recently diagnosed HIV-infected adults from routine pre-ART care in a rural district hospital in Kenya: a cohort study.
abstract: OBJECTIVE
  To determine the rate and predictors of early loss to follow-up (LTFU) for recently diagnosed HIV-infected, antiretroviral therapy (ART)-ineligible adults in rural Kenya.
  
  
  METHODS
  Prospective cohort study. Clients registering for HIV care between July 2008 and August 2009 were followed up for 6 months. Baseline data were used to assess predictors of pre-ART LTFU (not returning for care within 2 months of a scheduled appointment), LTFU before the second visit and LTFU after the second visit. Logistic regression was used to determine factors associated with LTFU before the second visit, while Cox regression was used to assess predictors of time to LTFU and LTFU after the second visit.
  
  
  RESULTS
  Of 530 eligible clients, 178 (33.6%) were LTFU from pre-ART care (11.1/100 person-months). Of these, 96 (53.9%) were LTFU before the second visit. Distance (>5 km vs. <1 km: adjusted hazard ratio 2.6 [1.9-3.7], P < 0.01) and marital status (married vs. single: 0.5 [0.3-0.6], P < 0.01) independently predicted pre-ART LTFU. Distance and marital status were independently associated with LTFU before the second visit, while distance, education status and seasonality showed weak evidence of predicting LTFU after the second visit. HIV disease severity did not predict pre-ART LTFU.
  
  
  CONCLUSIONS
  A third of recently diagnosed HIV-infected, ART-ineligible clients were LTFU within 6 months of registration. Predictors of LTFU among ART-ineligible clients are different from those among clients on ART. These findings warrant consideration of an enhanced pre-ART care package aimed at improving retention and timely ART initiation.
authors.affiliation: KEMRI/Wellcome Trust Centre for Geographic Medicine Research (Coast), Kilifi, Kenya. ahassan@kilifi.kemri-wellcome.org
authors.forename: Amin S
authors.initials: AS
authors.lastname: Hassan
authors.forename: Katherine L
authors.initials: KL
authors.lastname: Fielding
authors.forename: Nahashon M
authors.initials: NM
authors.lastname: Thuo
authors.forename: Helen M
authors.initials: HM
authors.lastname: Nabwera
authors.forename: Eduard J
authors.initials: EJ
authors.lastname: Sanders
authors.forename: James A
authors.initials: JA
authors.lastname: Berkley
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D019380:Anti-HIV Agents / Q000627:therapeutic use*; D004522:Educational Status; D005260:Female; D005500:Follow-Up Studies; D015658:HIV Infections / Q000188:drug therapy*; D006297:Health Services Accessibility; D006767:Hospitals, District; D006780:Hospitals, Rural; D006801:Humans; D007630:Kenya; D059012:Lost to Follow-Up; D008297:Male; D017533:Marital Status; D008875:Middle Aged; D010349:Patient Compliance; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012621:Seasons; D012923:Social Class; D055815:Young Adult
chemical_list: D019380:Anti-HIV Agents