Document Detail


Return to normal life after AIDS as a reason for lost to follow-up in a community-based antiretroviral treatment program.
MedLine Citation:
PMID:  22622076     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVES: To understand reasons for lost-to-follow-up (LTFU) from a community-based antiretroviral therapy program in Uganda.
STUDY DESIGN: Retrospective cohort of patients LTFU between May 31, 2001, to May 31, 2010, was examined. A representative sample of 579 patients traced to ascertain their outcomes.
METHODS: Mixed methods were used. Using "stopped care" as the hazard and "self-transferred" as the comparator, we examined using Cox proportional multivariable model risk factors for stopping care.
RESULTS: Overall, 2933 of 3954 (74.0%) patients were LTFU. Of 579 of 2933 (19%) patients sampled for tracing, 32 (5.5%) were untraceable, 66(11.4 %) were dead, and 481 (83.0%) found alive. Of those found alive, 232 (40.0%) stopped care, 249 (43.0%) self-transferred, whereas 61 (12.7%) returned to care at Reach Out Mbuya HIV/AIDS Initiative. In adjusted hazards ratios, born-again religion, originating from outside Kampala, resident in Kampala for <5 years but >1 year, having school-age children who were out of school, non-HIV disclosure, CD4 counts >250 cells per cubic millimeter and pre-antiretroviral therapy were associated with increased risk of stopping care. Qualitative interviews revealed return to a normal life as a key reason for LTFU. Of 61 patients who returned to care, their median CD4 count at LTFU was higher than on return into care (401/mm³ vs. 205/mm³, P < 0.0001).
CONCLUSIONS: Many patients become LTFU during the course of years, necessitating the need for effective mechanisms to identify those in need of close monitoring. Efforts should be made to improve referrals and mechanisms to track patients who transfer to different facilities. Additionally, tracing of patients who become LTFU is required to convince them to return.
Authors:
Stella T Alamo; Robert Colebunders; Joseph Ouma; Pamela Sunday; Glenn Wagner; Fred Wabwire-Mangen; Marie Laga
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Journal of acquired immune deficiency syndromes (1999)     Volume:  60     ISSN:  1944-7884     ISO Abbreviation:  J. Acquir. Immune Defic. Syndr.     Publication Date:  2012 Jun 
Date Detail:
Created Date:  2012-05-24     Completed Date:  2012-07-25     Revised Date:  2014-01-09    
Medline Journal Info:
Nlm Unique ID:  100892005     Medline TA:  J Acquir Immune Defic Syndr     Country:  United States    
Other Details:
Languages:  eng     Pagination:  e36-45     Citation Subset:  IM; X    
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MeSH Terms
Descriptor/Qualifier:
Acquired Immunodeficiency Syndrome / drug therapy*
Adolescent
Adult
Anti-HIV Agents / administration & dosage*
Cohort Studies
Female
Humans
Lost to Follow-Up*
Male
Middle Aged
Retrospective Studies
Risk Factors
Uganda
Young Adult
Grant Support
ID/Acronym/Agency:
R24 HD056651/HD/NICHD NIH HHS
Chemical
Reg. No./Substance:
0/Anti-HIV Agents
Comments/Corrections

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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