title: Factors Associated with Retention to Care in an HIV Clinic in Gabon, Central Africa.
abstract: BACKGROUND
  Retention to HIV care is vital for patients' survival, to prevent onward transmission and emergence of drug resistance. Travelling to receive care might influence adherence. Data on the functioning of and retention to HIV care in the Central African region are limited.
  
  
  METHODS
  This retrospective study reports outcomes and factors associated with retention to HIV care at a primary HIV clinic in Lambaréné, Gabon. Adult patients who presented to this clinic between January 2010 and January 2012 were included. Outcomes were retention in care (defined as documented show-up for clinical visits, regardless of delay) or LTFU (defined as a patient not retained in care; on ART or ART naïve, not returning to care during the study period with a patient delay for scheduled visits of more than 6 months), and mortality. Cox regression analysis was used to assess factors associated with respective outcomes. Qualitative data on reasons for LTFU were obtained from focus-group discussions.
  
  
  RESULTS
  Of 223 patients included, 67.3% were female. The mean age was 40.5 (standard deviation 11.4) years and the median CD4 count 275 (interquartile range 100.5-449.5) cells/μL. In total, 34.1% were lost to follow up and 8.1% died. Documented tuberculosis was associated with increased risk of being LTFU (adjusted hazard ratio (aHR) 1.80, 95% confidence interval (95% CI) 1.05-3.11, P = 0.03), whereas early starting anti-retroviral therapy (ART) was associated with a decreased risk of LTFU (aHR 0.43, 95%CI 0.24-0.76, P = 0.004), as was confirmed by qualitative data.
  
  
  CONCLUSIONS
  Retention to HIV care in a primary clinic in Gabon is relatively poor and interventions to address this should be prioritized in the HIV program. Early initiation of ART might improve retention in care.
authors.affiliation: Center of Tropical Medicine and Travel Medicine, Department of Infectious Diseases, Division of Internal Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands; Centre de Traitement Ambulatoire, Lambaréné, Gabon; Centre de Recherches Médicales de Lambaréné (CERMEL), Lambaréné, Gabon; Institute of Tropical Medicine, University of Tübingen, Tübingen, Germany; Clinical Infectious Diseases Research Initiative, Institute for Infectious Diseases and Molecular Medicine, University of Cape Town, Cape Town, South Africa.
authors.forename: Saskia
authors.initials: S
authors.lastname: Janssen
authors.affiliation: Center of Tropical Medicine and Travel Medicine, Department of Infectious Diseases, Division of Internal Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
authors.forename: Rosanne Willemijn
authors.initials: RW
authors.lastname: Wieten
authors.affiliation: Center of Tropical Medicine and Travel Medicine, Department of Infectious Diseases, Division of Internal Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands; Centre de Recherches Médicales de Lambaréné (CERMEL), Lambaréné, Gabon.
authors.forename: Sebastiaan
authors.initials: S
authors.lastname: Stolp
authors.affiliation: Center of Tropical Medicine and Travel Medicine, Department of Infectious Diseases, Division of Internal Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands; Centre de Recherches Médicales de Lambaréné (CERMEL), Lambaréné, Gabon.
authors.forename: Anne Lia
authors.initials: AL
authors.lastname: Cremers
authors.affiliation: Centre de Traitement Ambulatoire, Lambaréné, Gabon.
authors.forename: Elie Gide
authors.initials: EG
authors.lastname: Rossatanga
authors.affiliation: Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands; Division of Epidemiology, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
authors.forename: Kerstin
authors.initials: K
authors.lastname: Klipstein-Grobusch
authors.affiliation: Center of Tropical Medicine and Travel Medicine, Department of Infectious Diseases, Division of Internal Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands; Centre de Recherches Médicales de Lambaréné (CERMEL), Lambaréné, Gabon; Institute of Tropical Medicine, University of Tübingen, Tübingen, Germany; Department of Pediatric Pneumology and Immunology, Charité-Universitätsmedizin, Berlin, Germany.
authors.forename: Sabine
authors.initials: S
authors.lastname: Belard
authors.affiliation: Center of Tropical Medicine and Travel Medicine, Department of Infectious Diseases, Division of Internal Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands; Centre de Recherches Médicales de Lambaréné (CERMEL), Lambaréné, Gabon; Institute of Tropical Medicine, University of Tübingen, Tübingen, Germany; Clinical Infectious Diseases Research Initiative, Institute for Infectious Diseases and Molecular Medicine, University of Cape Town, Cape Town, South Africa.
authors.forename: Martin Peter
authors.initials: MP
authors.lastname: Grobusch
mesh_terms: D000328:Adult; D000554:Ambulatory Care Facilities / Q000706:statistics & numerical data*; D019380:Anti-HIV Agents / Q000627:therapeutic use; D005260:Female; D005681:Gabon; D015658:HIV Infections / Q000188:drug therapy*; D006801:Humans; D059012:Lost to Follow-Up; D008297:Male; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data*; D014195:Travel
chemical_list: D019380:Anti-HIV Agents