title: Risk factors for loss to follow-up prior to ART initiation among patients enrolling in HIV care with CD4+ cell count ≥200 cells/μL in the multi-country MTCT-Plus Initiative.
abstract: BACKGROUND
  In resource-limited settings, many HIV-infected patients are lost to follow-up (LTF) before starting ART; risk factors among those not eligible for ART at enrollment into care are not well described.
  
  
  METHODS
  We examined data from 4,278 adults (3,613 women, 665 men) enrolled in HIV care through March 2007 in the MTCT-Plus Initiative with a CD4 count ≥200 cells/mm(3) and WHO stage ≤ 2 at enrollment. Patients were considered LTF if > 12 months elapsed since their last clinic visit. Gender-specific Cox regression models were used to assess LTF risk factors.
  
  
  RESULTS
  The proportion LTF was 8.2 % at 12 months following enrollment, and was higher among women (8.4 %) than men (7.1 %). Among women, a higher risk of LTF was associated with younger age (adjusted hazard ratio [AHR]15-19/30+: 2.8, 95 % CI:2.1-3.6; AHR20-24/30+:1.9, 95 % CI:1.7-2.2), higher baseline CD4 count (AHR350-499/200-349:1.5; 95 % CI:1.0-2.1; AHR500+/200-349:1.5; 95 % CI:1.0-2.0), and being pregnant at the last clinic visit (AHR:1.9, 95 % CI:1.4-2.5). Factors associated with a lower risk of LTF included, employment outside the home (AHR:0.73, 95 % CI:0.59-0.90), co-enrollment of a family/household member (AHR:0.40, 95 % CI:0.26-0.61), and living in a household with ≥4 people (AHR:0.74, 95 % CI:0.64-0.85). Among men, younger age (AHR15-19/30+: 2.1, 95 % CI:1.2-3.5 and AHR30-34/35+:1.5, 95 % CI:1.0-2.4) had a higher risk of LTF. Electricity in the home (AHR:0.61, 95 % CI:0.41-0.91) and living in a household with ≥4 people (AHR:0.58, 95 % CI:0.39-0.85) had a lower risk of LTF.
  
  
  CONCLUSIONS
  Socio-economic status and social support may be important determinants of retention in patients not yet eligible for ART. Among women of child-bearing age, strategies around sustaining HIV care during and after pregnancy require attention.
authors.affiliation: ICAP at Columbia University, Mailman School of Public Health, New York, NY, USA. cgwynn@health.nyc.gov.|Department of Health and Mental Hygiene, New York, NY, USA. cgwynn@health.nyc.gov.
authors.forename: R Charon
authors.initials: RC
authors.lastname: Gwynn
authors.affiliation: Department of Medicine, Boston Medical Center, Boston, MA, USA. ashraf.fawzy@bmc.org.
authors.forename: Ashraf
authors.initials: A
authors.lastname: Fawzy
authors.affiliation: ICAP at Columbia University, Mailman School of Public Health, Cote de Ivoire, New York, NY, USA. ida.viho@aviso.ci.
authors.forename: Ida
authors.initials: I
authors.lastname: Viho
authors.affiliation: ICAP at Columbia University, Mailman School of Public Health, New York, NY, USA. yw2322@columbia.edu.
authors.forename: Yingfeng
authors.initials: Y
authors.lastname: Wu
authors.affiliation: ICAP at Columbia University, Mailman School of Public Health & College of Physicians & Surgeons, Columbia University, New York, NY, USA. eja1@cumc.columbia.edu.
authors.forename: Elaine J
authors.initials: EJ
authors.lastname: Abrams
authors.affiliation: Epidemiology and Biostatistics Program, CUNY School of Public Health, New York, NY, USA. dnash@hunter.cuny.edu.
authors.forename: Denis
authors.initials: D
authors.lastname: Nash
mesh_terms: D000293:Adolescent; D000328:Adult; D000553:Ambulatory Care; D044966:Anti-Retroviral Agents / Q000627:therapeutic use*; D018791:CD4 Lymphocyte Count; D005191:Family Characteristics; D005260:Female; D005500:Follow-Up Studies; D015658:HIV Infections / Q000188:drug therapy*; D006801:Humans; D015994:Incidence; D038622:Internationality; D059012:Lost to Follow-Up; D008297:Male; D008875:Middle Aged; D011247:Pregnancy; D016016:Proportional Hazards Models; D012307:Risk Factors; D012944:Social Support; D055815:Young Adult
chemical_list: D044966:Anti-Retroviral Agents