Dalal, Rishikesh P

MacPhail, Catherine

Mqhayi, Mmabatho

Wing, Jeff

Feldman, Charles

Chersich, Matthew F

Venter, Willem D F

2008

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 6 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. Death 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 whom 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 1 in 6 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.

Journal of Acquired Immune Deficiency Syndromes, 47(1), p. 101-107

1944-7884

1525-4135

https://hdl.handle.net/1959.11/16558

en

Lippincott Williams & Wilkins

Characteristics and Outcomes of Adult Patients Lost to Follow-Up at an Antiretroviral Treatment Clinic in Johannesburg, South Africa

Journal Article

Publication