Not all are lost: interrupted laboratory monitoring, early death, and loss to follow-up (LTFU) in a large South African treatment program

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dc.contributor.authorAhonkhai, Aima Aen_ZA
dc.contributor.authorNoubary, Farzaden_ZA
dc.contributor.authorMunro, Alisonen_ZA
dc.contributor.authorStark, Ruthen_ZA
dc.contributor.authorWilke, Marisaen_ZA
dc.contributor.authorFreedberg, Kenneth Aen_ZA
dc.contributor.authorWood, Robinen_ZA
dc.contributor.authorLosina, Elenaen_ZA
dc.date.accessioned2015-11-23T12:25:46Z
dc.date.available2015-11-23T12:25:46Z
dc.date.issued2012en_ZA
dc.description.abstractBACKGROUND: Many HIV treatment programs in resource-limited settings are plagued by high rates of loss to follow-up (LTFU). Most studies have not distinguished between those who briefly interrupt, but return to care, and those more chronically lost to follow-up. METHODS: We conducted a retrospective cohort study of 11,397 adults initiating antiretroviral therapy (ART) in 71 Southern African Catholic Bishops Conference/Catholic Relief Services HIV treatment clinics between January 2004 and December 2008. We distinguished among patients with early death, within the first 7 months on ART; patients with interruptions in laboratory monitoring (ILM), defined as missing visits in the first 7 months on ART, but returning to care by 12 months; and those LTFU, defined as missing all follow-up visits in the first 12 months on ART. We used multilevel logistic regression models to determine patient and clinic-level characteristics associated with these outcomes. RESULTS: In the first year on ART, 60% of patients remained in care, 30% missed laboratory visits, and 10% suffered early death. Of the 3,194 patients who missed laboratory visits, 40% had ILM, resuming care by 12 months. After 12 months on ART, patients with ILM had a 30% increase in detectable viremia compared to those who remained in care. Risk of LTFU decreased with increasing enrollment year, and was lowest for patients who enrolled in 2008 compared to 2004 [OR 0.49, 95%CI 0.39-0.62]. CONCLUSIONS: In a large community-based cohort in South Africa, nearly 30% of patients miss follow-up visits for CD4 monitoring in the first year after starting ART. Of those, 40% have ILM but return to clinic with worse virologic outcomes than those who remain in care. The risk of chronic LTFU decreased with enrollment year. As ART availability increases, interruptions in care may become more common, and should be accounted for in addressing program LTFU.en_ZA
dc.identifier.apacitationAhonkhai, A. A., Noubary, F., Munro, A., Stark, R., Wilke, M., Freedberg, K. A., ... Losina, E. (2012). Not all are lost: interrupted laboratory monitoring, early death, and loss to follow-up (LTFU) in a large South African treatment program. <i>PLoS One</i>, http://hdl.handle.net/11427/15285en_ZA
dc.identifier.chicagocitationAhonkhai, Aima A, Farzad Noubary, Alison Munro, Ruth Stark, Marisa Wilke, Kenneth A Freedberg, Robin Wood, and Elena Losina "Not all are lost: interrupted laboratory monitoring, early death, and loss to follow-up (LTFU) in a large South African treatment program." <i>PLoS One</i> (2012) http://hdl.handle.net/11427/15285en_ZA
dc.identifier.citationAhonkhai, A. A., Noubary, F., Munro, A., Stark, R., Wilke, M., Freedberg, K. A., ... & Losina, E. (2012). Not all are lost: interrupted laboratory monitoring, early death, and loss to follow-up (LTFU) in a large South African treatment program. PLoS One, 7(3), e32993. doi:10.1371/journal.pone.0032993en_ZA
dc.identifier.ris TY - Journal Article AU - Ahonkhai, Aima A AU - Noubary, Farzad AU - Munro, Alison AU - Stark, Ruth AU - Wilke, Marisa AU - Freedberg, Kenneth A AU - Wood, Robin AU - Losina, Elena AB - BACKGROUND: Many HIV treatment programs in resource-limited settings are plagued by high rates of loss to follow-up (LTFU). Most studies have not distinguished between those who briefly interrupt, but return to care, and those more chronically lost to follow-up. METHODS: We conducted a retrospective cohort study of 11,397 adults initiating antiretroviral therapy (ART) in 71 Southern African Catholic Bishops Conference/Catholic Relief Services HIV treatment clinics between January 2004 and December 2008. We distinguished among patients with early death, within the first 7 months on ART; patients with interruptions in laboratory monitoring (ILM), defined as missing visits in the first 7 months on ART, but returning to care by 12 months; and those LTFU, defined as missing all follow-up visits in the first 12 months on ART. We used multilevel logistic regression models to determine patient and clinic-level characteristics associated with these outcomes. RESULTS: In the first year on ART, 60% of patients remained in care, 30% missed laboratory visits, and 10% suffered early death. Of the 3,194 patients who missed laboratory visits, 40% had ILM, resuming care by 12 months. After 12 months on ART, patients with ILM had a 30% increase in detectable viremia compared to those who remained in care. Risk of LTFU decreased with increasing enrollment year, and was lowest for patients who enrolled in 2008 compared to 2004 [OR 0.49, 95%CI 0.39-0.62]. CONCLUSIONS: In a large community-based cohort in South Africa, nearly 30% of patients miss follow-up visits for CD4 monitoring in the first year after starting ART. Of those, 40% have ILM but return to clinic with worse virologic outcomes than those who remain in care. The risk of chronic LTFU decreased with enrollment year. As ART availability increases, interruptions in care may become more common, and should be accounted for in addressing program LTFU. DA - 2012 DB - OpenUCT DO - 10.1371/journal.pone.0032993 DP - University of Cape Town J1 - PLoS One LK - https://open.uct.ac.za PB - University of Cape Town PY - 2012 T1 - Not all are lost: interrupted laboratory monitoring, early death, and loss to follow-up (LTFU) in a large South African treatment program TI - Not all are lost: interrupted laboratory monitoring, early death, and loss to follow-up (LTFU) in a large South African treatment program UR - http://hdl.handle.net/11427/15285 ER - en_ZA
dc.identifier.urihttp://hdl.handle.net/11427/15285
dc.identifier.urihttp://dx.doi.org/10.1371/journal.pone.0032993
dc.identifier.vancouvercitationAhonkhai AA, Noubary F, Munro A, Stark R, Wilke M, Freedberg KA, et al. Not all are lost: interrupted laboratory monitoring, early death, and loss to follow-up (LTFU) in a large South African treatment program. PLoS One. 2012; http://hdl.handle.net/11427/15285.en_ZA
dc.language.isoengen_ZA
dc.publisherPublic Library of Scienceen_ZA
dc.publisher.departmentDesmond Tutu HIV Centreen_ZA
dc.publisher.facultyFaculty of Health Sciencesen_ZA
dc.publisher.institutionUniversity of Cape Town
dc.rightsThis is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.en_ZA
dc.rights.holder© 2012 Ahonkhai et alen_ZA
dc.rights.urihttp://creativecommons.org/licenses/by/4.0en_ZA
dc.sourcePLoS Oneen_ZA
dc.source.urihttp://journals.plos.org/plosoneen_ZA
dc.subject.otherAntiretroviral therapyen_ZA
dc.subject.otherHIVen_ZA
dc.subject.otherClinical laboratoriesen_ZA
dc.subject.otherSouth Africaen_ZA
dc.subject.otherGovernment laboratoriesen_ZA
dc.subject.otherViral loaden_ZA
dc.subject.otherAfricansen_ZA
dc.subject.otherAdultsen_ZA
dc.titleNot all are lost: interrupted laboratory monitoring, early death, and loss to follow-up (LTFU) in a large South African treatment programen_ZA
dc.typeJournal Articleen_ZA
uct.type.filetypeText
uct.type.filetypeImage
uct.type.publicationResearchen_ZA
uct.type.resourceArticleen_ZA
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