title: Loss to Follow-up Trends in HIV-Positive Patients Receiving Antiretroviral Treatment in Asia From 2003 to 2013.
abstract: Over time, there has been a substantial improvement in antiretroviral treatment (ART) programs, including expansion of services and increased patient engagement. We describe time trends in, and factors associated with, loss to follow-up (LTFU) in HIV-positive patients receiving ART in Asia.
  
  
  
  Analysis included HIV-positive adults initiating ART in 2003-2013 at 7 ART programs in Asia. Patients LTFU had not attended the clinic for ≥180 days, had not died, or transferred to another clinic. Patients were censored at recent clinic visit, follow-up to January 2014. We used cumulative incidence to compare LTFU and mortality between years of ART initiation. Factors associated with LTFU were evaluated using a competing risks regression model, adjusted for clinical site.
  
  
  
  A total of 8305 patients were included. There were 743 patients LTFU and 352 deaths over 26,217 person-years (pys), a crude LTFU, and mortality rate of 2.83 (2.64-3.05) per 100 pys and 1.34 (1.21-1.49) per 100 pys, respectively. At 24 months, the cumulative LTFU incidence increased from 4.3% (2.9%-6.1%) in 2003-05 to 8.1% (7.1%-9.2%) in 2006-09 and then decreased to 6.7% (5.9%-7.5%) in 2010-13. Concurrently, the cumulative mortality incidence decreased from 6.2% (4.5%-8.2%) in 2003-05 to 3.3% (2.8%-3.9%) in 2010-13. The risk of LTFU reduced in 2010-13 compared with 2006-09 (adjusted subhazard ratio = 0.73, 0.69-0.99).
  
  
  
  LTFU rates in HIV-positive patients receiving ART in our clinical sites have varied by the year of ART initiation, with rates declining in recent years whereas mortality rates have remained stable. Further increases in site-level resources are likely to contribute to additional reductions in LTFU for patients initiating in subsequent years.
authors.affiliation: *Biostatistics and Databases Program, The Kirby Institute, UNSW Sydney, Sydney, NSW, Australia; †National Center for HIV/AIDS, Dermatology and STDs, Phnom Penh, Cambodia; ‡National Hospital for Tropical Diseases, Hanoi, Vietnam; §Department of Internal Medicine, Tropical and Infectious Diseases, Udayana University and Sanglah Hospital, Bali, Indonesia; ‖Bach Mai Hospital, Hanoi, Vietnam; ¶Department of Medicine, Queen Elizabeth Hospital, Hong Kong, China; **Department of Internal Medicine and AIDS Research Institute, Yonsei University College of Medicine, Severance Hospital, Seoul, South Korea; ††TREAT Asia, amfAR-The Foundation for AIDS Research, Bangkok, Thailand; and ‡‡Department of Infectious Diseases, Tan Tock Seng Hospital, Novena, Singapore.
authors.forename: Nicole L
authors.initials: NL
authors.lastname: De La Mata
authors.forename: Penh S
authors.initials: PS
authors.lastname: Ly
authors.forename: Kinh V
authors.initials: KV
authors.lastname: Nguyen
authors.forename: Tuti P
authors.initials: TP
authors.lastname: Merati
authors.forename: Thuy T
authors.initials: TT
authors.lastname: Pham
authors.forename: Man P
authors.initials: MP
authors.lastname: Lee
authors.forename: Jun Y
authors.initials: JY
authors.lastname: Choi
authors.forename: Jeremy
authors.initials: J
authors.lastname: Ross
authors.forename: Matthew G
authors.initials: MG
authors.lastname: Law
authors.forename: Oon T
authors.initials: OT
authors.lastname: Ng
mesh_terms: D000328:Adult; D000368:Aged; D044966:Anti-Retroviral Agents / Q000627:therapeutic use*; D001208:Asia; D005260:Female; D015658:HIV Infections / Q000188:drug therapy* / Q000401:mortality; D006801:Humans; D015994:Incidence; D059012:Lost to Follow-Up; D008297:Male; D008875:Middle Aged; D018570:Risk Assessment; D055815:Young Adult
chemical_list: D044966:Anti-Retroviral Agents