title: Death and seeking alternative therapy largely accounted for lost to follow-up of patients on ART in northwest Ethiopia: a community tracking survey.
abstract: BACKGROUND
  Antiretroviral treatment programs in sub-Saharan African countries are highly affected by LTF. Tracking patients lost to follow-up and understanding their status is essential to maintain program quality and to develop targeted interventions to prevent LTF. We aimed to determine the outcome and factors associated with LTF.
  
  
  METHODS
  A lost to follow-up community tracking survey was conducted to determine the reasons, outcomes and factors associated with LTF at the University of Gondar Hospital, northwest Ethiopia. All patients were tracked at home to ascertain outcome status for lost to follow-up (death and non-death losses).
  
  
  RESULTS
  Out of the 551 patients LTF, 486 (88.20%) were successfully tracked. Death was the most common reason accounted for 233 (47.94%) of the lost to follow-up. Reasons for non-deaths losses include: stopped antiretroviral treatment due to different reasons, 135(53.36%), and relocation to another antiretroviral treatment program by self-transfer, 118(46.64%). The rate of mortality in the first six months was 72.12 per 100 person-years (95% CI: 61.80-84.24) but this sharply decreased after 12 months to 7.92 per 100 person-years (95% CI: 4.44-14.41). Baseline clinical characteristics were strongly associated with mortality.
  
  
  CONCLUSIONS
  Death accounts for about half of the loss to follow up. Most deaths occur in the first six months of loss. Seeking alternative therapy is another major reason for loss to follow up. Early tracking mechanisms are necessary to prevent death.
authors.affiliation: Institute of Public Health, University of Gondar, Gondar, Ethiopia. mamo_wubshet@yahoo.com
authors.forename: Mamo
authors.initials: M
authors.lastname: Wubshet
authors.forename: Yemane
authors.initials: Y
authors.lastname: Berhane
authors.forename: Alemayehu
authors.initials: A
authors.lastname: Worku
authors.forename: Yigzaw
authors.initials: Y
authors.lastname: Kebede
mesh_terms: D044966:Anti-Retroviral Agents / Q000627:therapeutic use*; D000529:Complementary Therapies / Q000706:statistics & numerical data; D003643:Death; D005002:Ethiopia / Q000453:epidemiology; D005500:Follow-Up Studies; D015658:HIV Infections / Q000188:drug therapy* / Q000453:epidemiology*; D006801:Humans; D053208:Kaplan-Meier Estimate; D059012:Lost to Follow-Up; D055118:Medication Adherence; D016016:Proportional Hazards Models
chemical_list: D044966:Anti-Retroviral Agents