Factors associated with loss to follow up among HIV positive clients started on anti-retroviral therapy under the test-and treat treatment guidelines in Luwero District

Abstract

Introduction: Following the World Health Organization (WHO) recommendations in 2015 that all persons diagnosed with human immunodeficiency virus (HIV) be started on antiretroviral therapy (ART) immediately termed as Test-and-treat, the number of people who are initiated on ART increased. There is a possibility that a surge in patient numbers coupled with initiation of largely asymptomatic patients as a result of test-and-treat, might accelerate the likelihood of patients getting loss to follow up (LTFU). This study seeks to determine factors associated with LTFU among patients following ART initiation in the test-and-treat era.Methods: This was unmatched case control study of 234 (78 cases 156 controls) patients drawn from routine patients‘ data for HIV clients enrolled in January – March 2020 in selected high volume facilities in Luwero District. Logistic regression was used to identify factors associated with lost to follow up. The results were further supported by Key informant interviews to explore the perceptions of health workers toward the test-and-treat policy and the risk of LTFU.Results: Overall, females accounted for more than 50% of the study participants in both groups. The Median age (IQR) was 30.5(25-39) among cases and 31.5(26-40.5) among controls. Majority of the study participants were married with more than 50% in both groups. The factors associated with LTFU were earning >30,000 (95% CI, 1.58-13.40), receiving care from government facilities (aOR=2.57, 95% CI, 1.16-5.67), spending limited time with health workers (aOR=3.97, 95% CI, 1.10-14.37 and HIV clinics have long patients‘ queues (aOR=2.41, 95% CI, 0.97-6.00). Inadequate counselling and transport issues were the prominent reasons for LTFU reported from Key informant interviews. Conclusion: Findings from the study indicate that delays for people living with HIV to enroll into HIV care and treatment and same day initiation of ART are not associated with loss to follow up. The factors associated with loss to follow up included participants who earned