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High rate of loss to clinical follow up among African HIV-infected patients attending a London clinic: a retrospective analysis of a clinical cohort

By Anat Rosenthal, PhD | 05 Aug, 2010

Abstract

Background
Long-term regular clinic follow up is an important component of HIV care. We determined the frequency and characteristics of HIV-infected patients lost to follow up from a London HIV clinic, and factors associated with loss to all HIV follow up in the UK.

Methods
We identified 1859 HIV-infected adults who had registered and attended a London clinic on one or more occasions between January 1997 and December 2005. Loss to follow up was defined as clinic non-attendance for one or more years. Through anonymized linkage with the Survey of Prevalent HIV Infections Diagnosed national database of all HIV patients in care in
the UK up to December 2006, loss-to-follow-up patients were categorized as “transfers” (subsequently received care at another UK HIV clinic) or “UKLFU” (no record of subsequent attendance at any HIV clinic in the UK). Logistic regression analysis was used to identify factors associated with “UKLFU” for those both on highly active antiretroviral therapy (HAART) and not on HAART.

Results
In total, 722 (38.8%) of 1859 patients were defined as lost to follow up. Of these, 347 (48.1%)were “transfers” and 375 (51.9%), or 20.2% of all patients, were UKLFU. Overall, 11.9% of all patients receiving HAART, and 32.2% not receiving HAART were UKLFU. Among those on HAART, risk factors for “UKLFU” were: African heterosexual female (OR=2.22, 95% CI: 1.11-4.56) versus white men who have sex with men; earlier year of HIV clinic registration
(1997-1999 OR: 3.51, 95% CI: 1.97-6.26; 2000-02 OR: 2.49, 95% CI: 1.43-4.32 vs. 2003-2005); CD4 count of <200 versus >350 cells/mm3 (OR=1.99, 95% CI:1.05-3.74); and a detectable viral load of >400 copies/ml (OR=5.03, 95% CI: 2.95-8.57 vs. ≤400 copies/ml) at last clinic visit. Among those not receiving HAART, factors were: African heterosexual male (OR=3.91, 95% CI: 1.77-8.64) versus white men who have sex with men; earlier HIV clinic registration (2000-2002 OR: 2.91, 95% CI: 1.77-4.78; 1997-1999: OR: 5.26, 95% CI: 2.71-10.19); and a CD4 count of <200 cells/ mm3 (OR: 3.24, 95% CI: 1.49-7.04).

Conclusions
One in five HIV-infected patients (one in three not on HAART and one in nine on HAART)from a London clinic were lost to all clinical follow up in the UK. Black African ethnicity, earlier year of clinic registration and advanced immunological suppression were the most important predictors of UKLFU. There is a need for all HIV clinics to establish systems for monitoring and tracing loss-to-follow-up patients, and to implement strategies for improving retention in care.

Attached resource:
  • High rate of loss to clinical follow up among African HIV-infected patients attending a London clinic: a retrospective analysis of a clinical cohort (download, 275.7 KB)

    Summary: Abstract

    Background
    Long-term regular clinic follow up is an important component of HIV care. We determined the frequency and characteristics of HIV-infected patients lost to follow up from a London HIV clinic, and factors associated with loss to all HIV follow up in the UK.

    Methods
    We identified 1859 HIV-infected adults who had registered and attended a London clinic on one or more occasions between January 1997 and December 2005. Loss to follow up was defined as clinic non-attendance for one or more years. Through anonymized linkage with the Survey of Prevalent HIV Infections Diagnosed national database of all HIV patients in care in
    the UK up to December 2006, loss-to-follow-up patients were categorized as “transfers” (subsequently received care at another UK HIV clinic) or “UKLFU” (no record of subsequent attendance at any HIV clinic in the UK). Logistic regression analysis was used to identify factors associated with “UKLFU” for those both on highly active antiretroviral therapy (HAART) and not on HAART.

    Results
    In total, 722 (38.8%) of 1859 patients were defined as lost to follow up. Of these, 347 (48.1%)were “transfers” and 375 (51.9%), or 20.2% of all patients, were UKLFU. Overall, 11.9% of all patients receiving HAART, and 32.2% not receiving HAART were UKLFU. Among those on HAART, risk factors for “UKLFU” were: African heterosexual female (OR=2.22, 95% CI: 1.11-4.56) versus white men who have sex with men; earlier year of HIV clinic registration
    (1997-1999 OR: 3.51, 95% CI: 1.97-6.26; 2000-02 OR: 2.49, 95% CI: 1.43-4.32 vs. 2003-2005); CD4 count of <200 versus >350 cells/mm3 (OR=1.99, 95% CI:1.05-3.74); and a detectable viral load of >400 copies/ml (OR=5.03, 95% CI: 2.95-8.57 vs. ≤400 copies/ml) at last clinic visit. Among those not receiving HAART, factors were: African heterosexual male (OR=3.91, 95% CI: 1.77-8.64) versus white men who have sex with men; earlier HIV clinic registration (2000-2002 OR: 2.91, 95% CI: 1.77-4.78; 1997-1999: OR: 5.26, 95% CI: 2.71-10.19); and a CD4 count of <200 cells/ mm3 (OR: 3.24, 95% CI: 1.49-7.04).

    Conclusions
    One in five HIV-infected patients (one in three not on HAART and one in nine on HAART)from a London clinic were lost to all clinical follow up in the UK. Black African ethnicity, earlier year of clinic registration and advanced immunological suppression were the most important predictors of UKLFU. There is a need for all HIV clinics to establish systems for monitoring and tracing loss-to-follow-up patients, and to implement strategies for improving retention in care.

    Source: Journal of the International AIDS Society

    Publication Date: August 4, 2010

    Language: English

    Keywords: LTFU, Migrant Populations, Monitoring & Measurement, UK

Replies

 

sulaiman Kawooya Replied at 5:36 AM, 28 Oct 2012

thanks for this resource.in our program we have employed a linkage coordinator,who does the calling of patients who miss their appointments,those lost to follow up.but she seems to be unearthing the issue of self transfers.as in they leave without getting transfer out forms.but also the issues of globalization,immigration,socioeconomic factors,Geo-topography etc these days are driving this notion seriously.

This Community is Archived.

This community is no longer active as of December 2018. Thanks to those who posted here and made this information available to others visiting the site.