Disclosure of HIV status and its impact on the loss in the follow-up of HIV-infected patients on potent anti-retroviral therapy programs in a (post-) conflict setting: A retrospective cohort study from Goma, Democratic Republic of Congo.
BACKGROUND
The study aimed to identify the impact of non-disclosure of HIV status on the loss to follow-up (LTFU) of patients receiving anti-retroviral therapy.


METHODS
A historic cohort of HIV patients from 2 major hospitals in Goma, Democratic Republic of Congo was followed from 2004 to 2012. LTFU was defined as not taking an ART refill for a period of 3 months or longer since the last attendance, and had not yet been classified as 'dead' or 'transferred-out'. Kaplan-Meier plots were used to determine the probability of LTFU as a function of time as inclusive of the cohort. The log-rank test was used to compare survival curves based on determinants. Cox proportional hazard modeling was used to measure predictors of LTFU from the time of treatment induction until December 15th, 2012 (the end-point).


RESULTS
The median follow-up time was 3.99 years (IQR = 2.33 to 5.59). Seventy percent of patients had shared their HIV status with others (95% CI: 66.3-73.1). The proportion of LTFU was 12% (95%CI: 9.6-14.4). Patients who did not share their HIV status (Adjusted HR 2.28, 95% CI 1.46-2.29), patients who did not live in the city of Goma (Adjusted HR 1.97, 95% CI 1.02-3.77), and those who attained secondary or higher education level (Adjusted HR 1.60, 95% CI 1.02-2.53) had a higher hazard of being LTFU.


CONCLUSIONS
This study shows the relationship between the non-disclosure HIV status and LTFU. Healthcare workers in similar settings should pay more attention to clients who have not disclosed their HIV status, and to those living far from health settings where they receive medication.
Kinshasa School of Public Health, University of Kinshasa, Kinshasa, Democratic Republic of Congo.
Pierre Zalagile
PZ
Akilimali
Department of Global Health and Socio-Epidemiology, Kyoto University School of Public Health, Kyoto, Japan.
Patou Masika
PM
Musumari
Department of Global Health and Primary Care, Centre for International Health, University of Bergen, Bergen, Norway.
Espérance
E
Kashala-Abotnes
Kinshasa School of Public Health, University of Kinshasa, Kinshasa, Democratic Republic of Congo.
Patrick Kalambayi
PK
Kayembe
Department of Internal Medicine, University of Kinshasa, Kinshasa, Democratic Republic of Congo.
François B
FB
Lepira
Kinshasa School of Public Health, University of Kinshasa, Kinshasa, Democratic Republic of Congo.
Paulin Beya
PB
Mutombo
Department of Global Health and Primary Care, Centre for International Health, University of Bergen, Bergen, Norway.
Thorkild
T
Tylleskar
Kinshasa School of Public Health, University of Kinshasa, Kinshasa, Democratic Republic of Congo.
Mapatano Mala
MM
Ali
D000328:Adult; D023241:Antiretroviral Therapy, Highly Active; D018791:CD4 Lymphocyte Count; D015023:Democratic Republic of the Congo / Q000453:epidemiology; D030881:Disclosure; D005260:Female; D005500:Follow-Up Studies; D015658:HIV Infections / Q000188:drug therapy / Q000453:epidemiology* / Q000821:virology*; D006801:Humans; D015994:Incidence; D059012:Lost to Follow-Up; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D019562:Viral Load