Factors associated with loss to follow up in HIV positive clients on ARVs at Infectious Disease Clinic, Mulago Hospital from 2005 to 2007
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Background: Worldwide there approximately 40.3 million people with HIV of which 25.8million are in the sub Saharan region of Africa. In Uganda over 1million ( 100,000 children under 15years) people are infected with HIV(MOH 2009).There is a significant increase in accessibility of ART to HIV infected patients in Uganda and Africa at large. In Uganda the average number receiving ART care by March 2009 180,974 (10,000 children). However there is an increasing proportion of patients accessing ART who are lost to follow up. The magnitude, associated factors and reasons for loss to follow up of ART in Uganda are not well understood Objectives: To determine the factors associated with loss to follow-up of HIV infected patients on ARVs. Methods: An unmatched case control study of 428(214 case and 214 controls) HIV patients 18years and above and receiving ARVs from the Infectious Disease Clinic from 2005-2007 was conducted. Patients who consistently did not attend the clinic for more than 3months from their next appointment date were identified as cases. Controls of the cases lost to follow-up were randomly selected from regularly followed up HIV infected patients on ARVs who attended the Infectious Disease Clinic during the same period as the cases. Socio-demographic factors such as (age, sex, marital status) and clinical factors such as (CD4 count at initiation of ARVs) were measured using both quantitative and qualitative methods. Results: The risk of patients failing to return to the clinic for care (LTFP) at multivariate analysis was increased by patient taking first line ART regimen(OR=3.23 CI 1.19-8.77) as was patients with CD4 ≤200cells/ml before starting HAART (OR=15 CI 8.19-27.57) . Patients lacking employment (OR=3.37 CI 1.90-5.96) and with duration of less than 4years since joining the clinic (OR=8.69 CI 4.96-15.32) were also strongly associated with LTFP. Patients with a next clinic appointment of less than one month (OR=0.29 CI 0.14-0.62) were less likely to be LTFP Conclusions: Factors of a lower CD4 count, taking first line ART regimen, failure to access some form of employment, and patients with less experience at the clinic are strong predictors of LTFP. Patients given periods of less than one month before next clinic visits were less likely to get LTFP. Strategies to emphasize counseling such patients with similar characteristics at an early stage should be put in place in order to prevent and reduce LTFP especially in resource limited countries like Uganda.