Abstract
:
Abstract Background Retention of patients initiated on antiretroviral therapy (ART) and good adherence remain cornerstones to long-term viral suppression. In this era of test and treat (T&T), ensuring that patients initiated on ART remain connected to HIV clinics will be key to the achievement of the UNAIDS 90-90-90 targets. Currently, limited studies have evaluated the effect instant ART initiation has on loss to follow up in a typical service healthcare setting. We studied the cumulative incidence, incidence rate of loss to follow up (LTFU), and factors associated with loss to follow up (LTFU) in a primary healthcare clinic that has practiced test and treat since 2012. Methods We retrospectively drew routine program data of patients initiated on ART from January 2012 to December 2016. We defined LTFU as failure of a patient to return to the HIV clinic for at least 90 days from the date of their last appointment. We calculated cumulative incidence, incidence rate and fitted a multivariable Cox proportion hazards regression model to determine factors associated with LTFU. Results Of the 8,136 patients included in our sample, 3,606 (44.3%) started ART within seven days of HIV diagnosis. Females were 62.3%, median (interquartile range) age at start of ART was 30 (25, 37) years, 50.1% had access to a mobile phone, 54.0% had a baseline CD4 cell count of Conclusion Initiation of ART within 7 days of an HIV diagnosis was associated with an elevated risk of loss to follow up. Steep ART initiation needs to be backed by enhanced adherence and retention counseling to reach the 2020 UNAIDS goals and beyond.