title: Implementation and Operational Research: Risk Factors of Loss to Follow-up Among HIV-Positive Pediatric Patients in Dar es Salaam, Tanzania.
abstract: OBJECTIVE
  To identify risk factors for loss to follow-up (LTFU) in an HIV-infected pediatric population in Dar es Salaam, Tanzania, between 2004 and 2011.
  
  
  METHODS
  Longitudinal analysis of 6236 HIV-infected children.
  
  
  METHODS
  We conducted a prospective cohort study of 6236 pediatric patients enrolled in care and treatment in Dar es Salaam from October 2004 to September 2011. LTFU was defined as missing a clinic visit for >90 days for patients on ART and for >180 days for patients in care and monitoring. The relationship of baseline and time-varying characteristics to the risk of LTFU was examined using a Cox proportional hazards model.
  
  
  RESULTS
  A total of 2130 children (34%) were LTFU over a median follow-up of 16.7 months (interquartile range, 3.4-36.9). Factors independently associated with a higher risk of LTFU were age ≤2 years (relative risk [RR] = 1.59, 95% CI: 1.40 to 1.80), diarrhea at enrollment (RR = 1.20, 95% CI: 1.03 to 1.41), a low mid-upper arm circumference for age (RR = 1.20, CI: 1.05 to 1.37), eating protein-rich foods ≤3 times a week (RR = 1.39, 95% CI: 1.05 to 1.90), taking cotrimoxazole (RR = 1.39, 95% CI: 1.06 to 1.81), initiating onto antiretrovirals (RR = 1.37, 95% CI: 1.17 to 1.61), receiving treatment at a hospital instead of a local facility (RR = 1.39, 95% CI: 1.06 to 1.41), and starting treatment in 2006 or later (RR = 1.10, 95% CI: 1.04 to 1.16).
  
  
  CONCLUSIONS
  Health workers should be aware of pediatric patients who are at a greatest risk of LTFU, such as younger and undernourished patients, so that they can proactively counsel families about the importance of visit adherence. Findings support decentralization of HIV care to local facilities as opposed to hospitals.
authors.affiliation: Departments of *Epidemiology; †Global Health and Population, Harvard School of Public Health, Boston, MA; ‡Management and Development for Health, Dar es Salaam, Tanzania; §Department of Pediatrics and Child Health, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania; ‖Division of GI/Nutrition, Clinical Nutrition Service, Children's Hospital, Boston, MA; ¶Departments of Global Health and Population, Epidemiology, and Nutrition, Harvard School of Public Health, Boston, MA; and #Departments of Epidemiology, Biostatistics, Global Health and Population, and Nutrition, Harvard School of Public Health, Boston, MA.
authors.forename: Nora M
authors.initials: NM
authors.lastname: McCormick
authors.forename: Nan
authors.initials: N
authors.lastname: Li
authors.forename: David
authors.initials: D
authors.lastname: Sando
authors.forename: Aisa
authors.initials: A
authors.lastname: Muya
authors.forename: Karim P
authors.initials: KP
authors.lastname: Manji
authors.forename: Rodrick
authors.initials: R
authors.lastname: Kisenge
authors.forename: Christopher
authors.initials: C
authors.lastname: Duggan
authors.forename: Guerino
authors.initials: G
authors.lastname: Chalamilla
authors.forename: Wafaie W
authors.initials: WW
authors.lastname: Fawzi
authors.forename: Donna
authors.initials: D
authors.lastname: Spiegelman
mesh_terms: D019380:Anti-HIV Agents / Q000627:therapeutic use*; D002648:Child; D002664:Child Nutritional Physiological Phenomena; D002675:Child, Preschool; D004044:Dietary Proteins; D005260:Female; D015658:HIV Infections / Q000453:epidemiology*; D006801:Humans; D059012:Lost to Follow-Up; D008297:Male; D044342:Malnutrition; D012307:Risk Factors; D013636:Tanzania / Q000453:epidemiology; D015662:Trimethoprim, Sulfamethoxazole Drug Combination / Q000627:therapeutic use
chemical_list: D019380:Anti-HIV Agents; D004044:Dietary Proteins; D015662:Trimethoprim, Sulfamethoxazole Drug Combination