title: Lost to follow-up: failure to engage children in care in the first three months of diagnosis.
abstract: Loss to follow-up (LTFU) is a critical factor in determining clinical outcomes in HIV treatment programs. Identifying modifiable factors of LTFU is fundamental for designing effective patient-retention interventions. We analyzed factors contributing to children LTFU from a treatment program to identify those that can be modified. A case-control study involving 313 children was used to compare the sociodemographic and clinical characteristics of children LTFU (cases) with those remaining in care (controls) at a large pediatric HIV care setting in Botswana. We traced children through caregiver contacts and those we found, we conducted structured interviews with patients' caregivers. Children <5 years were nearly twice as likely as older children to be LTFU (57·8% versus 30·9%, p <0 .01). Approximately half (47·6%, n = 51) of LTFU patients failed to further engage in care after just one clinic visit, as compared to less than 1% (n = 2) in the control group (p < 0.01). Children LTFU were more likely than controls to have advanced disease, greater immunosuppression, and not to be receiving antiretroviral therapy. Among interviewed patient caregivers, psychosocial factors (e.g., stigma, religious beliefs, child rebellion, disclosure of HIV status) were characteristics of patients LTFU, but not of controls. Socioeconomic factors (e.g., lack of transportation, school-related activities, forgetting appointments) were cited predominantly by the controls. Pediatric patients and their caregivers need to be targeted and engaged at their initial clinic visit, with special attention to children <5 years. Possible interventions include providing psychosocial support for issues that deter patients from engaging with The Clinic. Collaboration with community-based organizations focused on reducing stigma may be useful in addressing these complex issues.
authors.affiliation: a Department of Pediatrics , Baylor College of Medicine , Houston , TX , USA.
authors.forename: Edwin Masese
authors.initials: EM
authors.lastname: Machine
authors.affiliation: a Department of Pediatrics , Baylor College of Medicine , Houston , TX , USA.
authors.forename: Susan L
authors.initials: SL
authors.lastname: Gillespie
authors.affiliation: b The University of Texas Health Science Center at Houston (UT Health) School of Public Health , Houston , TX , USA.
authors.forename: Nuria
authors.initials: N
authors.lastname: Homedes
authors.affiliation: b The University of Texas Health Science Center at Houston (UT Health) School of Public Health , Houston , TX , USA.
authors.forename: Beatrice J
authors.initials: BJ
authors.lastname: Selwyn
authors.affiliation: c Department of Family Medicine and Community Health , University of Minnesota Medical School , Minneapolis , MN , USA.
authors.forename: Michael W
authors.initials: MW
authors.lastname: Ross
authors.affiliation: d Botswana-Baylor Children's Clinical Centre of Excellence , Gaborone , Botswana.
authors.forename: Gabriel
authors.initials: G
authors.lastname: Anabwani
authors.affiliation: a Department of Pediatrics , Baylor College of Medicine , Houston , TX , USA.
authors.forename: Gordon
authors.initials: G
authors.lastname: Schutze
authors.affiliation: a Department of Pediatrics , Baylor College of Medicine , Houston , TX , USA.
authors.forename: Mark W
authors.initials: MW
authors.lastname: Kline
mesh_terms: D000293:Adolescent; D001902:Botswana; D017028:Caregivers; D016022:Case-Control Studies; D002648:Child; D002675:Child, Preschool; D005260:Female; D015658:HIV Infections / Q000188:drug therapy* / Q000276:immunology; D006801:Humans; D007223:Infant; D059012:Lost to Follow-Up; D008297:Male; D010342:Patient Acceptance of Health Care; D012067:Religion; D012720:Severity of Illness Index; D057545:Social Stigma; D012959:Socioeconomic Factors; D013997:Time Factors; D014186:Transportation; D014342:Truth Disclosure
keywords: HIV; loss to follow-up; pediatric; psychosocial factors; socioeconomic factors