Time-Dependent Predictors of Loss to Follow-Up in a Large HIV Treatment Cohort in Nigeria.
BACKGROUND
Most evaluations of loss to follow-up (LTFU) in human immunodeficiency virus (HIV) treatment programs focus on baseline predictors, prior to antiretroviral therapy (ART) initiation. As risk of LTFU is a continuous issue, the aim of this evaluation was to augment existing information with further examination of time-dependent predictors of loss.


METHODS
This was a retrospective evaluation of data collected between 2004 and 2012 by the Harvard School of Public Health and the AIDS Prevention Initiative in Nigeria as part of PEPFAR-funded program in Nigeria. We used multivariate modeling methods to examine associations between CD4(+) cell counts, viral load, and early adherence patterns with LTFU, defined as no refills collected for at least 2 months since the last scheduled appointment.


RESULTS
Of 51 953 patients initiated on ART between 2004 and 2011, 14 626 (28%) were LTFU by 2012. Factors associated with increased risk for LTFU were young age, having nonincome-generating occupations or no education, being unmarried, World Health Organization (WHO) stage, having a detectable viral load, and lower CD4(+) cell counts. In a subset analysis, adherence patterns during the first 3 months of ART were associated with risk of LTFU by month 12.


CONCLUSIONS
In settings with limited resources, early adherence patterns, as well as CD4(+) cell counts and unsuppressed viral load, at any time point in treatment are predictive of loss and serve as effective markers for developing targeted interventions to reduce rates of attrition.
Harvard School of Public Health.
Seema Thakore
ST
Meloni
Harvard School of Public Health.
Charlotte
C
Chang
Harvard School of Public Health.
Beth
B
Chaplin
Harvard School of Public Health ; Brigham and Women's Hospital , Boston, Massachusetts.
Holly
H
Rawizza
AIDS Prevention Initiative Nigeria, Ltd./Gte. , Abuja.
Oluwatoyin
O
Jolayemi
AIDS Prevention Initiative Nigeria, Ltd./Gte. , Abuja.
Bolanle
B
Banigbe
AIDS Prevention Initiative Nigeria, Ltd./Gte. , Abuja.
Prosper
P
Okonkwo
Harvard School of Public Health.
Phyllis
P
Kanki
ART outcomes; HIV; attrition; loss to follow-up; retention