Rate and predictors of loss to follow-up in HIV care in a low-resource setting: analyzing critical risk periods

By identifying when HIV-positive individuals are most at risk of dropping out, healthcare providers can create better strategies to keep more people engaged in their treatment—and ultimately, help reduce the spread of HIV.

Published in Biomedical Research

Rate and predictors of loss to follow-up in HIV care in a low-resource setting: analyzing critical risk periods
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BioMed Central
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Rate and predictors of loss to follow-up in HIV care in a low-resource setting: analyzing critical risk periods - BMC Infectious Diseases

Background Patient loss-to-follow-up (LTFU) in HIV care is a major challenge, especially in low-resource settings. Although the literature has focused on the total rate at which patients disengage from care, it has not sufficiently examined the specific risk periods during which patients are most likely to disengage from care. By addressing this gap, researchers and healthcare providers can develop more targeted interventions to improve patient engagement in HIV care. Methods We conducted a retrospective cohort study on newly enrolled adult HIV patients at seven randomly selected high-volume health facilities in Ethiopia from May 2022 to April 2024. Data analysis was performed using SPSS version 26, with a focus on the incidence rate of LTFU during the critical risk periods. Cumulative hazard analysis was used to compare event distributions, whereas a Poisson regression model was used to identify factors predicting LTFU, with statistical significance set at p < 0.05. Results The analysis included 737 individuals newly enrolled in HIV care; 165 participants (22.4%, 95% CI: 19.5–25.2) were LTFU by the end of two years, of which 50.1% occurred within the first 6 months, 29.7% within 7–12 months, and 19.4% from 13 to 24 months on ART. The overall incidence rate of LTFU was 18.3 per 1,000 PMO (95% CI: 15.9–20.6), with rates of 167.7 in the first 6 months, 55.4 in 7–12 months, and 18.1 in 13–24 months. Incomplete addresses lacking a phone number or location information (IRR: 1.61; 95% CI: 1.14, 2.27) and poor adherence (IRR: 1.78; 95% CI: 1.28, 2.48) were factors predicting the incidence rate of LTFU. Conclusion LTFU peaked in the first 6 months, accounting for approximately half of total losses, remained elevated from months 7–12, and stabilized after the first year of HIV care and treatment. Address information and adherence were predictors of LTFU. To effectively minimize LTFU, efforts should focus on intensive support during the first six months of care, followed by sustained efforts and monitoring in the next six months. Our findings highlight a critical period for targeted interventions to reduce LTFU in HIV care.

Why Do Some People Stop HIV Treatment? Understanding the Key Moments

In the global fight against HIV, keeping people engaged in their treatment is crucial. Even though many countries aim to meet ambitious HIV care goals by 2030, a significant challenge remains: helping those who start HIV treatment continue their care and keep their virus under control. A big part of this challenge is what’s known as "loss to follow-up" (LTFU).

What is Loss to Follow-Up (LTFU)?

LTFU happens when someone on HIV treatment misses their medical appointments or stops taking their medication for over 28 days. This is a serious issue, as it can lead to poorer health, increased risk of death, and a higher chance of spreading HIV to others because the virus isn’t being suppressed.

When Do People Stop Treatment?

This study looked at 737 adults who were new to HIV care and identified the times when they were most likely to stop their treatment:

  • The First 6 Months Are Critical: About 50% of the people who dropped out of care did so within the first six months. This early period is a high-risk time, with an LTFU rate nine times higher than later periods (13-24 months). People might face challenges like dealing with side effects, struggling to adjust to a new routine, or not yet seeing the benefits of the medication.
  • 7-12 Months: A Continued Risk: Even though the risk of dropping out decreases after the first six months, many people still struggle to stick with their treatment during months 7-12. About 30% of those who stopped care did so during this time. Factors like financial difficulties, stigma, or transportation issues can continue to affect them.
  • After 12 Months: A More Stable Phase: After a year on treatment, the dropout rate drops significantly. By this time, many patients have adjusted to their routine, seen improvements in their health, and are more committed to their treatment.

What Can We Do About It?

The findings suggest that the first six months of HIV treatment are a make-or-break time. Health programs should focus on providing extra support during this period, such as helping patients manage side effects and offering counseling. Continued support is also important in the following months to help people overcome challenges that might come up later.

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Life Sciences > Health Sciences > Biomedical Research > Pathogenesis > Infection > Infectious Diseases > HIV infections

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