Center for International Health, Education, and Biosecurity Kenya, University of Maryland, Nairobi, Kenya.
Institute of Human Virology, University of Maryland School of Medicine, Baltimore, Maryland, USA.
AIDS Res Hum Retroviruses. 2021 Sep;37(9):642-646. doi: 10.1089/AID.2020.0292. Epub 2021 May 25.
We investigated factors associated with loss to follow-up (LTFU) in 24 urban health facilities in Nairobi, Kenya. We conducted a retrospective analysis of routinely collected data to assess factors associated with LTFU in the period October 1, 2016, to June 30, 2017. LTFU was defined as no antiretroviral therapy (ART) refill for ≥90 days and no documentation of transfer, death, or treatment cessation in the patient chart, and if no lapse of ≥90 days between ART refills, patients were considered retained in care. Multivariable logistic regression modeling was used to compute odds ratios and 95% confidence interval (CI) for LTFU. Our analysis included 633 individuals who were LTFU and 13,098 individuals retained in care. Most participants (69.6%) were women, and median age was 33.0 years (interquartile range, 27.2-38.3 years). Median ART duration was shorter among those LTFU (0.4 years) than retained patients (2.5 years, < .0001). Being male [adjusted odds ratio (aOR) 1.30; 95% CI: 1.04-1.63, = .02], transferring into facilities while already receiving ART (aOR 11.58; 95% CI: 8.23-16.29, < .0001), and having a shorter ART duration (<6 months) were associated with increased odds of LTFU. Patients who transferred into a facility while already receiving ART had the highest adjusted odds of being LTFU compared with those retained in care. In this urban and highly mobile population, transferring into facilities while already receiving ART was strongly associated with LTFU. Focusing programming efforts on patients transferring between urban clinics to identify reasons for transfer and potential barriers to treatment adherence could help improve patient outcomes. Supplementary case management and support may be needed to promote a seamless transition and ensure uninterrupted engagement in HIV care and treatment.
我们调查了与肯尼亚内罗毕 24 家城市卫生机构的失访（LTFU）相关的因素。我们对常规收集的数据进行了回顾性分析，以评估 2016 年 10 月 1 日至 2017 年 6 月 30 日期间与 LTFU 相关的因素。LTFU 定义为无抗逆转录病毒治疗（ART）补充≥90 天，且患者病历中无转院、死亡或治疗终止记录，如果 ART 补充之间无≥90 天的时间间隔，则患者被认为在接受护理。多变量逻辑回归模型用于计算 LTFU 的优势比和 95%置信区间（CI）。我们的分析包括 633 名失访者和 13098 名留观者。大多数参与者（69.6%）为女性，中位年龄为 33.0 岁（四分位距，27.2-38.3 岁）。中位 ART 持续时间在失访者中较短（0.4 年），而在留观者中较长（2.5 年， < .0001）。男性（调整后的优势比[aOR] 1.30；95%CI：1.04-1.63， = .02）、在开始接受 ART 时转入设施（aOR 11.58；95%CI：8.23-16.29， < .0001）和 ART 持续时间较短（<6 个月）与 LTFU 的几率增加相关。与留观者相比，在开始接受 ART 时转入设施的患者具有最高的调整后 LTFU 优势比。在这个城市和流动性很强的人群中，在开始接受 ART 时转入设施与 LTFU 密切相关。关注在城市诊所之间转移的患者的项目工作，以确定转移的原因和治疗依从性的潜在障碍，可能有助于改善患者的结果。可能需要补充病例管理和支持，以促进顺利过渡，并确保患者不间断地参与艾滋病毒护理和治疗。
