Incidence and determinants of loss to follow up of HIV-1 infected patients on treatment at the Yaounde Jamot Hospital

Alain KUABAN
Haematology, Microbiology, Parasitology and Infectious Diseases, University of Yaounde 1
June, 2014
 

Abstract

Introduction:
The increasingly widespread use of combined antiretroviral therapy (cART) has substantially improved on the prognosis of human immunodeficiency virus (HIV) infection by changing its landscape from a highly fatal condition to a chronic illness. This has, unfortunately, been followed by the emergence of loss to follow-up (LTFU) as a legitimate threat to the success of antiretroviral therapy (ART) programmes. At a time when cART is dispensed free of charge in Cameroon, research on the incidence and determinants of LTFU in HIV infected patients on cART is quite relevant as knowledge of these can be useful in developing strategies to curb its occurrence.

Objectives:
The objectives of this study were to:
- Determine the incidence of LTFU among HIV-1 infected patients 12 months after initiating cART at the approved treatment centre (ATC) of the Yaounde Jamot Hospital (YJH).
- Identify the determinants of LTFU in these patients

Methods:
It was a retrospective cohort study conducted over a period of two years from January 2011 to December 2012. All previously untreated HIV-1 infected patients aged 18 years and above who were initiated on cART in 2011 and followed-up at the ATC of the YJH were included in the study. Information on socio-demographic characteristics, baseline biological characteristics and treatment regimens, as well as outcomes of treatment was extracted from each patient’s medical record. Patients who were at least two months late for scheduled appointment were considered as LTFU. The incidence of LTFU was calculated as the proportion of patients who became LTFU during the study period while multivariate logistic regression was used to identify its determinants.

Results:
A total of 793 patients fulfilled the inclusion criteria. There were 307 (38.7%) men and 486 (61.3%) women with a mean age of 39.45± 9.83 years. At the end of the 12 month period of follow-up 411 (51.8%) of the 793 patients studied were alive and on treatment while 305 were LTFU, giving a cumulative incidence of LTFU of 38.5%. Compared to patients who were alive and on cART, those LTFU were significantly more likely to be aged less than 40 years [OR: 1.56; 95% CI:1.13-2.15], of the male sex [OR: 1.66; 95% CI: 1.18-2.33], single patients [OR:1.83;95%CI :1.32-2.53], baseline CD4 cell counts<100/mm3 [OR:1.67; 95% CI:1.19-2.33]and no prescription of additional drugs during follow-up[OR: 2.97; 95% CI: 2.07- 4.27].
Conclusion and recommendations
The annual incidence of LTFU from cART among HIV1 infected patients in the ATC of the YJH is quite high. Age less than 40 years, the male sex, being single, having baseline CD4 cell count below 100/mm3 and no prescription of additional drugs during follow-up are independent determinants of LTFU at the ATC of the YJH. A prospective multi-site study to obtain a better view on the incidence and determinants of LTFU, as well as the close monitoring of patients who present these risk factors and the implementation of sensitization campaigns on the fact that HIV/AIDS is a chronic disease with a life-long treatment are therefore recommended.


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