Lost to follow-up

Loss to follow-up (LTFU) is a critical factor in determining clinical outcomes in HIV treatment programs. Identifying modifiable factors of LTFU is fundamental for designing effective patient-retention interventions. We analyzed factors contributing to children LTFU from a treatment program to identify those that can be modified. A case-control study involving 313 children was used to compare the sociodemographic and clinical characteristics of children LTFU (cases) with those remaining in care (controls) at a large pediatric HIV care setting in Botswana. We traced children through caregiver contacts and those we found, we conducted structured interviews with patients' caregivers. Children <5 years were nearly twice as likely as older children to be LTFU (57·8% versus 30·9%, p <0 .01). Approximately half (47·6%, n = 51) of LTFU patients failed to further engage in care after just one clinic visit, as compared to less than 1% (n = 2) in the control group (p < 0.01). Children LTFU were more likely than controls to have advanced disease, greater immunosuppression, and not to be receiving antiretroviral therapy. Among interviewed patient caregivers, psychosocial factors (e.g., stigma, religious beliefs, child rebellion, disclosure of HIV status) were characteristics of patients LTFU, but not of controls. Socioeconomic factors (e.g., lack of transportation, school-related activities, forgetting appointments) were cited predominantly by the controls. Pediatric patients and their caregivers need to be targeted and engaged at their initial clinic visit, with special attention to children <5 years. Possible interventions include providing psychosocial support for issues that deter patients from engaging with The Clinic. Collaboration with community-based organizations focused on reducing stigma may be useful in addressing these complex issues

Family medicine · Lost to follow-up · Population · Psychiatry · Psychological intervention · Psychosocial · Socioeconomic status · Adolescent Sexual and Reproductive Health · HIV Research and Treatment · HIV/AIDS Research and Interventions · Medicine · Internal Medicine · Pediatrics

• Predictors of loss to follow-up among children on long-term antiretroviral therapy in Zambia (2003–2015)

  Open Access•Jane N Mutanga, Simon Mutembo et al.•BMC Public Health•2019

  Añadir item

• Mitigating moral distress by enhancing healthcare workers’ understanding of challenges faced by carers of children with disabilities in low-resource settings in Kenya

  Open Access•Anne Geniets, Jarim Omogi et al.•Global Health Action•2025

  Añadir item

• “It is not possible to go inside and have a discussion”

  Open Access•Joanna Busza, Victoria Simms et al.•AIDS Care•2018

  Añadir item

• Antiretroviral Therapy Adherence, Virologic and Immunologic Outcomes in Adolescents Compared With Adults in Southern Africa

  Jean B Nachega, Michael Hislop et al.•JAIDS Journal of Acquired Immune…•2009

  Añadir item

• Patient Retention in Antiretroviral Therapy Programs in Sub-Saharan Africa

  Open Access•Sydney Rosen, Matthew P Fox et al.•PLoS Medicine•2007

  Añadir item

• HIV System Navigation

  Judith Bradford, Judith B Bradford et al.•AIDS Patient Care and STDs•2007

  Añadir item

• Hunger, waiting time and transport costs

  Anita Hardon, A P Hardon et al.•AIDS Care•2007

  Añadir item

• Loss to follow-up among youth accessing outpatient HIV care and treatment services in Kisumu, Kenya

  VO Ojwang’, Vincent Ojwang et al.•AIDS Care•2016

  Añadir item

• The orphan problem

  Anatoli Kamali, Janet Seeley et al.•AIDS Care•1996

  Añadir item

• Access to HIV prevention and care for HIV-exposed and HIV-infected children

  Open Access•Caroline De Schacht, Carlota Lucas et al.•BMC Public Health•2014

  Añadir item

• Transportation Costs Impede Sustained Adherence and Access to Haart in a Clinic Population in Southwestern Uganda

  Open Access•David M Tuller, David R Bangsberg et al.•AIDS and Behavior•2009

  Añadir item