Characteristics and outcomes of adult patients lost to follow-up at an antiretroviral treatment clinic in Johannesburg, South Africa | ICRH

Authors and affiliation: 

Rishikesh P. Dalal (Washington University School of Medicine)Catherine MacPhail (RHRU), Mmabatho Mqhayi (RHRU) and Willem D. F. Venter (RHRU)Jeff Wing (University of the Witwatersrand) and Charles Feldman (University of the Witwatersrand) Matthew F. Chersich (ICRH-Kenya)

Ranking: 

A1

Team members: 

Dr Mark Hawken, Dr Stanley Luchters, Mr. Nzioki Kingola, Mrs. Wilkister Ombidi, Ms. Margaret Mutungi, Mrs. Lily Baya, Ms. Bibi Mbete, Mrs. Mary Wambo and Ms. Khadija Khamis.;

PubMedID: 

PMID: 17971708

Published: 

J Acquir Immune Defic Syndr. 2008 Jan 1;47(1):101-7

Background: A significant proportion of those initiating antiretroviral treatment (ART) for HIV infection are lost to follow-up. Causes for discontinuing ART follow-up in resource-limited settings are not well understood. Methods: A retrospective analysis was conducted of all adult patients receiving ART at an urban public clinic in Johannesburg, South Africa between April 2004 and June 2005. Patients discontinuing follow up for at least six weeks were identified and further studied, and causes for treatment default were tabulated. Results: Of 1631 adult patients studied, 267 (16.4%) discontinued follow-up during the study period. Gender, ethnicity, and age were not predictive of loss to follow-up. Of those discontinuing follow-up, 173 (64.8%) were successfully traced. Deaths accounted for 48% (n = 83) of those traced. Characteristics associated with death were: older age at ART initiation (P = 0.022), lower baseline CD4 cell count (P = 0.0073), higher initial HIV RNA load (P = 0.024), and loss of weight on ART (P = 0.033). Date of death was known for 71% (n = 59) of patients traced deceased, of which 83% (n = 49) had died within 30 days of active ART. Common nonmortality losses included relocation or clinic transfer (25.4%) and hospitalization or illness not resulting in death (10.4%). Few cited financial difficulty or medication toxicity as reasons for discontinuing follow-up. Conclusions: Nearly one in six patients receiving ART in a resource-constrained setting had discontinued follow-up over a 15-month period. Early mortality was high, especially in those with profound immunosuppression. Improving access to care and streamlining patient tracking may improve ART outcomes.