Factors associated with pre-ART loss-to-follow up in adults in rural KwaZulu-Natal, South Africa: a prospective cohort studyReport as inadecuate




Factors associated with pre-ART loss-to-follow up in adults in rural KwaZulu-Natal, South Africa: a prospective cohort study - Download this document for free, or read online. Document in PDF available to download.

BMC Public Health

, 16:358

Global health

Abstract

BackgroundTimely initiation of antiretroviral treatment ART requires sustained engagement in HIV care before treatment eligibility. We assessed loss to follow-up LTFU correlates in HIV-positive adults accessing HIV treatment and care, not yet ART-eligible CD4 >500 cells-mm.

MethodsThis was a sub-study of a prospective cohort study focusing on sexual behaviour in an area of high HIV prevalence and widespread ART availability in rural KwaZulu-Natal, South Africa. Psychosocial, clinical and demographic data were collected at recruitment from individuals with CD4 >500 cells-mm. LTFU was defined as not attending clinic within 13 months of last visit or before death. Individuals starting ART were censored at ART initiation. Data were collected between January 2009 and January 2013. Analysis used Competing Risks regression.

ResultsTwo hundred forty-seven individuals 212 females were recruited median follow-up 2.13 years, total follow-up 520.15 person-years. 86 remained in pre-ART care 34.8 %, 94 were LTFU 38.1 %, 58 initiated ART 23.5 %, 7 died 2.8 %, 2 transferred out 0.8 %. The LTFU rate was 18.07 per 100 person-years 95 % CI 14.76–21.12. LTFU before a competing event was 13.5 % at one and 34.4 % at three years. Lower LTFU rates were significantly associated with age >37 versus ≤37 years: adjusted sub-Hazard ratio aSHR 0.51, 95 % CI 0.30–0.87, openness with family-friends a little versus not at all, aSHR 0.81, 95 % CI 0.45–1.43; a lot versus not at all, aSHR 1.57, 95 % CI 0.94–2.62, children 0 versus 4+, aSHR 0.68, 95 % CI 0.24–1.87; 1 versus 4+, aSHR 2.05 95 % CI 1.14–3.69, 2 versus 4+; aSHR 1.71, 95 % CI 0.94–3.09; 3 versus 4a, aSHR 1.14, 95 % CI 0.57–2.30, previous CD4 counts 1 versus 0, aSHR 0.81, 95 % CI 0.45–1.43; 2+ versus 0, aSHR 0.43, 95 % CI 0.25–0.73, and most recent partner HIV status not known versus HIV-positive, aSHR 0.77, 95 % CI 0.50–1.19; HIV-negative versus HIV-positive, aSHR 2.40, 95 % CI 1.18–4.88. The interaction between openness with family-friends and HIV partner disclosure was close to significance p = 0.06. Those who had neither disclosed to partners nor were open with family-friends had lowest LTFU rates.

ConclusionsStrategies to retain younger people in pre-ART care are required. How openness with others, partner HIV status and disclosure, and children relate to LTFU needs further exploration.

KeywordsHIV Pre-ART Loss-to-follow up South Africa Psychosocial  Download fulltext PDF



Author: Michael Evangeli - Marie-Louise Newell - Nuala McGrath

Source: https://link.springer.com/







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