Lost to follow-up

Failure to engage children in care in the first three months of diagnosis

Bibliographic Data

ID19440798
AuthorsEdwin Machine (0000-0001-8564-6000, Baylor College of Medicine, corresponding author), Edwin Masese Machine, Susan L Gillespie (Baylor College of Medicine), Nuria Homedes (0000-0002-3322-3951, University of Texas Health Science Center at Dallas), Beatrice J Selwyn (University of Texas Health Science Center at Dallas), Michael W Ro (0000-0002-5718-9989, University of Minnesota Medical Center), Michael W Ross, Gabriel Anabwani (0000-0002-8555-4373, Botswana-Baylor Children's Clinical Center of Excellence), Gordon E Schutze (Baylor College of Medicine), Gordon Schutze, Mark W Kline (Baylor College of Medicine)
Year2016
Volume28
Issue11
Pages1402-1410
Publication date2016-11-01
Peer ReviewedYes
Open AccessNo
TypeARTICLE
VenueAIDS Care (JOURNAL)
Journal identifiersISSN: 0954-0121 • E-ISSN: 1360-0451
PublisherInforma UK Limited (PUBLISHER • GB)
DOI10.1080/09540121.2016.1179714
PMID27160542
OpenAlexW2381693305
LanguageEN
Citations received3
References cited37

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