title: The association between self-reported stigma and loss-to-follow up in treatment eligible HIV positive adults in rural Kwazulu-Natal, South Africa.
abstract: BACKGROUND
  The relationship between loss-to-follow-up (LTFU) in HIV treatment and care programmes and psychosocial factors, including self-reported stigma, is important to understand. This prospective cohort study explored stigma and LTFU in treatment eligible adults who had yet not started antiretroviral therapy (ART).
  
  
  METHODS
  Psychosocial, clinical and demographic data were collected at a baseline interview. Self-reported stigma was measured with a multi-item scale. LTFU was defined as not attending clinic in the 90 days since last appointment or before death. Data was collected between January 2009 and January 2013 and analysed using Cox Regression.
  
  
  RESULTS
  380 individuals were recruited (median time in study 3.35 years, total time at risk 1065.81 person-years). 203 were retained (53.4%), 109 were LTFU (28.7%), 48 had died and were not LTFU at death (12.6%) and 20 had transferred out (5.3%). The LTFU rate was 10.65 per 100 person-years (95% CI: 8.48-12.34). 362 individuals (95.3%) started ART. Stigma total score (categorised in quartiles) was not significantly associated with LTFU in either univariable or multivariable analysis (adjusting for other variables in the final model): second quartile aHR 0.77 (95%CI: 0.41-1.46), third quartile aHR 1.20(95%CI: 0.721-2.04), fourth quartile aHR 0.62 (95%CI: 0.35-1.11). In the final multivariable model, higher LTFU rates were associated with male gender, increased openness with friends/family and believing that community problems would be solved at higher levels. Lower LTFU rates were independently associated with increased year of age, greater reliance on family/friends, and having children.
  
  
  CONCLUSIONS
  Demographic and other psychosocial factors were more closely related to LTFU than self-reported stigma. This may be consistent with high levels of social exposure to HIV and ART and with stigma affecting LTFU less than other stages of care. Research and clinical implications are discussed.
authors.affiliation: Department of Psychology, Royal Holloway University of London, United Kingdom.
authors.forename: Michael
authors.initials: M
authors.lastname: Evangeli
authors.affiliation: Africa Centre for Health and Population Studies, University of KwaZulu-Natal, Somkhele, South Africa ; Faculty of Medicine, University of Southampton, Southampton, United Kingdom.
authors.forename: Marie-Louise
authors.initials: ML
authors.lastname: Newell
authors.affiliation: Human Sciences Research Council, Durban, South Africa.
authors.forename: Linda
authors.initials: L
authors.lastname: Richter
authors.affiliation: Africa Centre for Health and Population Studies, University of KwaZulu-Natal, Somkhele, South Africa ; Academic Unit of Primary Care and Population Sciences and Division of Social Statistics and Demography, University of Southampton, Southampton, United Kingdom.
authors.forename: Nuala
authors.initials: N
authors.lastname: McGrath
mesh_terms: D000328:Adult; D015331:Cohort Studies; D005260:Female; D015658:HIV Infections / Q000188:drug therapy* / Q000453:epidemiology*; D006801:Humans; D059012:Lost to Follow-Up; D008297:Male; D016016:Proportional Hazards Models; D011446:Prospective Studies; D011584:Psychology; D012044:Regression Analysis; D012424:Rural Population; D057545:Social Stigma; D013019:South Africa / Q000453:epidemiology