title: Long-term health care interruptions among HIV-positive patients in Uganda.
abstract: BACKGROUND
  Retaining patients in clinical care is necessary to ensure successful antiretroviral treatment (ART) outcomes. Among patients who discontinue care, some reenter care at a later stage, whereas others are or will be lost from follow-up. We examined risk factors for health care interruptions and loss to follow-up within a cohort receiving ART in Uganda.
  
  
  METHODS
  Using a large hospital cohort providing free universal ART and HIV clinical care, we assessed characteristics and risk factors for treatment interruptions, defined as a 12-month absence from care at Mildmay, and loss to follow-up, defined as absence from care greater than 12 months without reengagement in care at Mildmay. We included patients aged 14 years and above. We assessed these outcomes over time using Kaplan-Meier analysis and multivariable regression.
  
  
  RESULTS
  Of 6970 eligible patients, 784 (11.2%) had a health care interruption of at least 12 months and 217 (3.1%) were lost to follow-up. Patients experiencing health care interruptions had higher baseline CD4 T-cell counts at ART initiation, defined as ≥ 250 cells per cubic millimeter [odds ratio (OR): 1.29, 95% confidence intervals (CI): 1.11 to 1.50], and lower levels of education (OR: 1.32, 95% CI: 1.09 to 1.61). Adolescents were much more likely to be lost to follow-up (OR: 3.11, 95% CI: 2.23 to 4.34). In contrast, having a partner (OR: 0.22, 95% CI: 0.16 to 0.31) or being sexually active at baseline (OR: 0.40, 95% CI: 0.28 to 0.55) was protective of loss to follow-up.
  
  
  CONCLUSIONS
  Within this cohort, long periods of unsupervised health care interruptions were common.
authors: University of Ottawa, Ottawa, Ontario, Canada. edward.mills@uottawa.ca
authors: Edward J
authors: EJ
authors: Mills
authors: Anna
authors: A
authors: Funk
authors: Steve
authors: S
authors: Kanters
authors: Esther
authors: E
authors: Kawuma
authors: Curtis
authors: C
authors: Cooper
authors: Barbara
authors: B
authors: Mukasa
authors: Mary
authors: M
authors: Odit
authors: Yvonne
authors: Y
authors: Karamagi
authors: Daniel
authors: D
authors: Mwehire
authors: Jean
authors: J
authors: Nachega
authors: Sanni
authors: S
authors: Yaya
authors: Amber
authors: A
authors: Featherstone
authors: Nathan
authors: N
authors: Ford
mesh_terms: D000328:Adult; D019380:Anti-HIV Agents / Q000627:therapeutic use*; D023241:Antiretroviral Therapy, Highly Active; D018791:CD4 Lymphocyte Count; D015331:Cohort Studies; D005260:Female; D015658:HIV Infections / Q000188:drug therapy*; D006801:Humans; D059012:Lost to Follow-Up; D008297:Male; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D014454:Uganda; D016903:Drug Monitoring
chemical_list: D019380:Anti-HIV Agents