School of Public Health, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia.
BMC Infect Dis. 2024 Oct 18;24(1):1176. doi: 10.1186/s12879-024-10089-6.
Patient loss-to-follow-up (LTFU) in HIV care is a major challenge, especially in low-resource settings. Although the literature has focused on the total rate at which patients disengage from care, it has not sufficiently examined the specific risk periods during which patients are most likely to disengage from care. By addressing this gap, researchers and healthcare providers can develop more targeted interventions to improve patient engagement in HIV care.
We conducted a retrospective cohort study on newly enrolled adult HIV patients at seven randomly selected high-volume health facilities in Ethiopia from May 2022 to April 2024. Data analysis was performed using SPSS version 26, with a focus on the incidence rate of LTFU during the critical risk periods. Cumulative hazard analysis was used to compare event distributions, whereas a Poisson regression model was used to identify factors predicting LTFU, with statistical significance set at p < 0.05.
The analysis included 737 individuals newly enrolled in HIV care; 165 participants (22.4%, 95% CI: 19.5-25.2) were LTFU by the end of two years, of which 50.1% occurred within the first 6 months, 29.7% within 7-12 months, and 19.4% from 13 to 24 months on ART. The overall incidence rate of LTFU was 18.3 per 1,000 PMO (95% CI: 15.9-20.6), with rates of 167.7 in the first 6 months, 55.4 in 7-12 months, and 18.1 in 13-24 months. Incomplete addresses lacking a phone number or location information (IRR: 1.61; 95% CI: 1.14, 2.27) and poor adherence (IRR: 1.78; 95% CI: 1.28, 2.48) were factors predicting the incidence rate of LTFU.
LTFU peaked in the first 6 months, accounting for approximately half of total losses, remained elevated from months 7-12, and stabilized after the first year of HIV care and treatment. Address information and adherence were predictors of LTFU. To effectively minimize LTFU, efforts should focus on intensive support during the first six months of care, followed by sustained efforts and monitoring in the next six months. Our findings highlight a critical period for targeted interventions to reduce LTFU in HIV care.
艾滋病毒护理中的患者失访（LTFU）是一个主要挑战，尤其是在资源匮乏的环境中。尽管文献已经关注了患者脱离护理的总比率，但尚未充分研究患者最有可能脱离护理的特定风险期。通过解决这一差距，研究人员和医疗保健提供者可以制定更有针对性的干预措施，以提高艾滋病毒护理中患者的参与度。
我们对 2022 年 5 月至 2024 年 4 月在埃塞俄比亚的七个随机选择的高容量卫生设施新入组的成年艾滋病毒患者进行了回顾性队列研究。使用 SPSS 版本 26 进行数据分析，重点关注关键风险期内 LTFU 的发生率。累积风险分析用于比较事件分布，而泊松回归模型用于确定预测 LTFU 的因素，统计显著性设置为 p<0.05。
该分析包括 737 名新入组的艾滋病毒护理患者；165 名参与者（22.4%，95%CI：19.5-25.2）在两年结束时失访，其中 50.1%发生在头 6 个月内，29.7%发生在 7-12 个月内，19.4%发生在接受抗逆转录病毒治疗的第 13 至 24 个月。总的 LTFU 发生率为每 1000 个患者月（PMO）18.3 例（95%CI：15.9-20.6），前 6 个月的发生率为 167.7 例，7-12 个月的发生率为 55.4 例，13-24 个月的发生率为 18.1 例。不完整的地址（缺少电话号码或位置信息）（IRR：1.61；95%CI：1.14,2.27）和不良依从性（IRR：1.78；95%CI：1.28,2.48）是预测 LTFU 发生率的因素。
LTFU 在头 6 个月内达到高峰，占总损失的一半左右，从第 7-12 个月开始仍居高不下，在接受艾滋病毒护理和治疗的第一年之后稳定下来。地址信息和依从性是 LTFU 的预测因素。为了有效降低 LTFU，应在护理的头 6 个月内集中精力提供强化支持，然后在接下来的 6 个月内持续努力并进行监测。我们的研究结果突出了一个关键时期，需要采取有针对性的干预措施来减少艾滋病毒护理中的 LTFU。
