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Tracing people living with HIV who are lost to follow-up at antiretroviral therapy programs in Southern Africa: A sampling-based study in six countries

Article scientifique 2020 Anglais

Résumé

Background: Attrition threatens the success of antiretroviral therapy (ART). In this cohort study, we examined outcomes of people living with HIV (PLHIV) lost to follow-up (LTFU) 2014-2017 at ART programs in Southern Africa.Methods: We confirmed LTFU (missed appointment for ≥60 or ≥90 days, according to local guidelines) by checking medical records and used a standardized protocol to trace a weighted random sample of PLHIV who were LTFU in eight ART programs in Lesotho, Malawi, Mozambique, South Africa, Zambia and Zimbabwe, 2017-2019. We ascertained vital status and identified predictors of mortality using logistic regression, adjusted for sex, age, time on ART, time since LTFU, travel time, and urban or rural setting.Results: Among 3,256 PLHIV, 385 (12%) were wrongly categorized as LTFU and 577 (17%) had missing contact details. We traced 2,294 PLHIV (71%) by phone calls, home visits or both: 768 (34% of 2,294) were alive and in care, including 385 (17%) silent transfers to another clinic; 528 (23%) were alive without care or unknown care; 252 (11%) had died. Overall, the status of 1,323 (41% of 3,256) PLHIV remained unknown. Mortality was higher in men than women, higher in children than in young people or adults, higher in PLHIV who had been on ART <1 year or lost >1 year, living further from the clinic or in rural areas. Results were heterogeneous across sites.Conclusions: Our study highlights the urgent need for better medical record systems at HIV clinics and rapid tracing of PLHIV who are LTFU.

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Christ, B., Ballif, M., Anderegg, N., Chammartin, F., Muhairwe, J., Jefferys, L., Dijk, J., Vinikoor, M., Lettow, M., Chimbetete, C., Phiri, S., Egger, M. (2020). Tracing people living with HIV who are lost to follow-up at antiretroviral therapy programs in Southern Africa: A sampling-based study in six countries. https://doi.org/10.31219/osf.io/mkhr3

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Auteur(s)

Benedikt Christ Marie Ballif Nanina Anderegg Frédérique Chammartin Josephine Muhairwe Laura Jefferys Janneke H. van Dijk Michael J. Vinikoor Monique van Lettow Cleophas Chimbetete Sam Phiri Matthias Egger

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