title: Trends in mortality and loss to follow-up in HIV care at the Nkongsamba Regional hospital, Cameroon.
abstract: BACKGROUND
  Access to Human Immunodeficiency Virus (HIV) care has been rolled out in Cameroon in the last decade through decentralised delivery of care and timely initiation of free antiretroviral drugs. We sought to describe the evolution of mortality and loss to follow up (LTFU) and their patient-related determinants at an HIV clinic which is facing significant challenges.
  
  
  METHODS
  A retrospective review of point of care data from HIV patients was conducted in June 2012 at Nkongsamba Regional Hospital in Cameroon to establish mortality and LTFU rates. Univariable and multivariable Cox regression models were used to screen for factors associated with the outcomes. Telephone calls were made to trace patients LTFU.
  
  
  RESULTS
  Between June 2005 and December 2010, 2388 HIV infected patients were admitted. Of these, 1858 were aged 15 and above and were included in our analysis. Their median age was 36 years (IQR: 30-44) and they were followed up over a total risk period of 3647.3 person-years (pyrs). The overall mortality rate was 34.6 deaths per 1000 pyrs (95% CI: 29.0-41.1) while the overall LTFU rate was 94.6 per 1000 pyrs (95%CI: 85.1-105.1).The mortality rates steadily rose to a peak of 69.6 deaths per 1000 pyrs in 2009 and then fell drastically to 20.6 per 1000 pyrs in 2010. The LTFU rate increased sharply from 29.7 in 2006 to 138.2 in 2007 and remained virtually stable until 2010. The factors associated with mortality were: being male (aHR=2.25, 95% CI: 1.58-3.19), clinical disease progression (aHR=2.0, 95% CI: 1.58-2.53), CD4 count<200 cells/μl (aHR=3.14, 95% CI: 1.27-7.73), haemoglobin level<10 g/dl (aHR=2.50, 95% CI: 1.69-3.69). Major factors associated with high LTFU rate were: distance to clinic of over 5 km (aHR=1.25, 95% CI: 1.00-1.55), being single, having partners with unknown HIV status or taking no treatment and with CD4 count>500 cells/μl. Two- thirds (66.7%) of traced LTFU patients were dead.
  
  
  CONCLUSIONS
  Mortality and LTFU rates in our cohort were high but there is evidence that patients' outcomes are improving. Interventions to address factors associated with high mortality and LTFU should be implemented for optimal results in patient care.
authors.affiliation: Centre Medical d'Arrondissement de Bare, PO Box 628, Nkongsamba, Cameroon. cavinep@yahoo.co.uk.
authors.forename: Cavin Epie
authors.initials: CE
authors.lastname: Bekolo
authors.forename: Jayne
authors.initials: J
authors.lastname: Webster
authors.forename: Moses
authors.initials: M
authors.lastname: Batenganya
authors.forename: Gerald Etapelong
authors.initials: GE
authors.lastname: Sume
authors.forename: Basile
authors.initials: B
authors.lastname: Kollo
mesh_terms: D000293:Adolescent; D000328:Adult; D000554:Ambulatory Care Facilities / Q000706:statistics & numerical data / Q000639:trends*; D019380:Anti-HIV Agents / Q000627:therapeutic use; D018791:CD4 Lymphocyte Count; D002163:Cameroon / Q000453:epidemiology; D005260:Female; D005500:Follow-Up Studies; D015658:HIV Infections / Q000188:drug therapy / Q000453:epidemiology / Q000401:mortality* / Q000473:pathology; D006801:Humans; D008297:Male; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D012307:Risk Factors; D016019:Survival Analysis
chemical_list: D019380:Anti-HIV Agents