n South African Medical Journal - Loss to follow-up in a community clinic in South Africa - roles of gender, pregnancy and CD4 count : original article
|Article Title||Loss to follow-up in a community clinic in South Africa - roles of gender, pregnancy and CD4 count : original article|
|© Publisher:||Health and Medical Publishing Group (HMPG)|
|Journal||South African Medical Journal|
|Author||Bingxia Wang, Elena Losina, Ruth Stark, Alison Munro, Rochelle P. Walensky, Marisa Wilke, Des Martin, Zhigang Lu, Kenneth A. Freedberg and Robin Wood|
|Publication Date||Jan 2011|
|Pages||253 - 257|
|Keyword(s)||Boston University School of Public Health, Catholic Relief Services South Africa, Harvard Medical School, University of Cape Town and University of Pretoria|
Background. Faith-based organisations have expanded antiretroviral therapy (ART) in community clinics across South Africa. Loss to follow-up (LTFU), however, limits the potential individual and population treatment benefits and optimal care.
Objective. To identify patient characteristics associated with LTFU 6 months after starting ART in a large community clinic.
Methods. Patients initiating ART between April 2004 and October 2006 in one South African Catholic Bishops' Conference HIV treatment clinic who had at least one follow-up visit were included and routinely monitored every 6 months after ART initiation. Standardised instruments were used to collect data. Rates of LTFU over time were estimated by the Kaplan-Meier method. The Cox proportional hazard regression examined the impact of age, baseline CD4 count, baseline HIV RNA, gender and pregnancy status on LTFU.
Results. Data from 925 patients (age >14 years, median age 36 years, 70% female, of whom 16% were pregnant) were included: 51 (6%) were lost to follow-up 6 months after ART initiation. Younger age (≤30 years) (hazard ratio (HR) 2.14, 95% confidence interval (CI) 1.05 - 4.38) and pregnancy for women (HR 3.75, 95% CI 1.53 - 9.16) were significantly associated with higher LTFU rates. When stratified by baseline CD4 count, gender and pregnancy status, pregnant women with lower baseline CD4 counts (≤200 cells/ μl) had 6.06 times the hazard (95% CI 2.20 - 16.71) of LTFU at 6 months compared with men.
Conclusions. HIV-infected pregnant women initiating ART were significantly more likely to be lost to follow-up in a community clinic in South Africa. Urgent interventions to successfully retain pregnant women in care are needed.
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