title: Male, mobile, and moneyed: loss to follow-up vs. transfer of care in an urban African antiretroviral treatment clinic.
abstract: OBJECTIVE
  The purpose of this study was to analyze characteristics, reasons for transferring, and reasons for discontinuing care among patients defined as lost to follow-up (LTFU) from an antiretroviral therapy (ART) clinic in Nairobi, Kenya.
  
  
  METHODS
  The study used a prospective cohort of patients who participated in a randomized, controlled ART adherence trial between 2006 and 2008.
  
  
  METHODS
  Participants were followed from pre-ART clinic enrollment to 18 months after ART initiation, and were defined as LTFU if they failed to return to clinic 4 weeks after their last scheduled visit. Reasons for loss were captured through phone call or home visit. Characteristics of LTFU who transferred care and LTFU who did not transfer were compared to those who remained in clinic using log-binomial regression to estimate risk ratios.
  
  
  RESULTS
  Of 393 enrolled participants, total attrition was 83 (21%), of whom 75 (90%) were successfully traced. Thirty-seven (49%) were alive at tracing and 22 (59%) of these reported having transferred their antiretroviral care. In the final model, transfers were more likely to have salaried employment [Risk Ratio (RR), 2.7; 95% confidence interval (CI), 1.2-6.1; p=0.020)] and pay a higher monthly rent (RR, 5.8; 95% CI, 1.3-25.0; p=0.018) compared to those retained in clinic. LTFU who did not transfer care were three times as likely to be men (RR, 3.1; 95% CI, 1.1-8.1; p=0.028) and nearly 4 times as likely to have a primary education or less (RR, 3.8; 95% CI, 1.3-10.6; p=0.013). Overall, the most common reason for LTFU was moving residence, predominantly due to job loss or change in employment.
  
  
  CONCLUSIONS
  A broad definition of LTFU may include those who have transferred their antiretroviral care and thereby overestimate negative effects on ART continuation. Interventions targeting men and considering mobility due to employment may improve retention in urban African ART clinics.
  
  
  RESULTS
  The study's ClinicalTrials.gov identifier is NCT00273780.
authors.affiliation: Department of Global Health, University of Washington, Seattle, Washington, United States of America.
authors.forename: Kara G
authors.initials: KG
authors.lastname: Marson
authors.forename: Kenneth
authors.initials: K
authors.lastname: Tapia
authors.forename: Pamela
authors.initials: P
authors.lastname: Kohler
authors.forename: Christine J
authors.initials: CJ
authors.lastname: McGrath
authors.forename: Grace C
authors.initials: GC
authors.lastname: John-Stewart
authors.forename: Barbra A
authors.initials: BA
authors.lastname: Richardson
authors.forename: Julia W
authors.initials: JW
authors.lastname: Njoroge
authors.forename: James N
authors.initials: JN
authors.lastname: Kiarie
authors.forename: Samah R
authors.initials: SR
authors.lastname: Sakr
authors.forename: Michael H
authors.initials: MH
authors.lastname: Chung
mesh_terms: D000328:Adult; D000554:Ambulatory Care Facilities; D019380:Anti-HIV Agents / Q000627:therapeutic use*; D002947:Cities; D005260:Female; D015658:HIV Infections / Q000188:drug therapy; D006801:Humans; D007630:Kenya; D059012:Lost to Follow-Up; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D005791:Patient Care / Q000191:economics* / Q000706:statistics & numerical data*; D010349:Patient Compliance / Q000706:statistics & numerical data*; D016032:Randomized Controlled Trials as Topic
chemical_list: D019380:Anti-HIV Agents