title: Implementation and Operational Research: High Loss to Follow-up Among Children on Pre-ART Care Under National AIDS Program in Madurai, South India.
abstract: BACKGROUND
  Information on the follow-up of HIV-infected children enrolled into preantiretroviral therapy (Pre-ART) care under routine program settings is limited in India. Knowledge on the magnitude of loss to follow-up (LFU) and its reasons will help programs to retain children in HIV care. We aimed to assess the proportion of LFU among children in Pre-ART care and its associated factors.
  
  
  METHODS
  In this retrospective cohort study, we reviewed the records of all HIV-infected children (aged <15 years) registered from 2005 to 2012 at an ART center, Madurai, South India. LFU during Pre-ART care was defined as having not visited the ART center within a year of registration.
  
  
  RESULTS
  Of 426 children enrolled in Pre-ART care, 211 (49%) were females and 301 (71%) were in the 5- to 14-year age group. At 1 year of registration, 348 (82%) were lost to follow-up. Of 348, 81 returned to care after 1 year of enrollment, whereas 267 (63% of all children) were permanently lost to follow-up. The proportion of LFU remained high from 2005 to 2012. WHO staging, CD4 count, and opportunistic infection were the significant factors associated with lost to follow-up on multivariate analysis.
  
  
  CONCLUSIONS
  LFU was alarmingly high indicating poor clinical and programmatic monitoring among HIV-infected children enrolled in Pre-ART care. A system for active tracing of those missing a clinic appointment intensified supervision, and monitoring along with qualitative research is urgently needed. This will help to understand the exact reasons for LFU based on which effective interventions may be planned for reducing such losses.
authors.affiliation: *National Institute for Research in Tuberculosis, Chennai, India; †International Union Against Tuberculosis and Lung Disease, South-East Asia Regional Office, New Delhi, India; ‡Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India; §ART Center, Government Rajaji Hospital, Madurai, India; and ‖National AIDS Control Organisation, New Delhi, India.
authors.forename: N Poorana
authors.initials: NP
authors.lastname: Ganga Devi
authors.forename: Kumar M V
authors.initials: KM
authors.lastname: Ajay
authors.forename: C
authors.initials: C
authors.lastname: Palanivel
authors.forename: Swaroop
authors.initials: S
authors.lastname: Sahu
authors.forename: M
authors.initials: M
authors.lastname: Selvaraj
authors.forename: A S
authors.initials: AS
authors.lastname: Valan
authors.forename: B B
authors.initials: BB
authors.lastname: Rewari
authors.forename: S
authors.initials: S
authors.lastname: Soumya
mesh_terms: D000163:Acquired Immunodeficiency Syndrome / Q000453:epidemiology / Q000517:prevention & control; D000293:Adolescent; D019380:Anti-HIV Agents / Q000008:administration & dosage* / Q000627:therapeutic use; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D005260:Female; D015658:HIV Infections / Q000188:drug therapy* / Q000453:epidemiology / Q000517:prevention & control; D006801:Humans; D007194:India / Q000453:epidemiology; D059012:Lost to Follow-Up; D008297:Male; D009313:National Health Programs / Q000458:organization & administration*; D010352:Patient Dropouts / Q000706:statistics & numerical data*; D012189:Retrospective Studies
chemical_list: D019380:Anti-HIV Agents