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Male, Mobile, and Moneyed: Loss to Follow-up vs. Transfer of Care in an Urban African Antiretroviral Treatment Clinic
Lost to follow-up or LTFU is a challenge in many low-resource settings that have limited resources to track and retain patients in care. Patients who miss clinic visits may run out of medications, have unmet social needs that are barriers to access including transport, or undiagnosed co-infections that could be addressed during a clinic visit. In HIV-care settings, LTFU may result in less optimal adherance levels which results in higher viral load levels. Understanding the timing and the reasons for missed clinic appointments can help identify alternative models of care to ensure HIV-infected patients receive continuous care.
This study was nested in a larger randomized trial conducted at the Coptic Hope Center in 2006. The main study compared adherence to treatment among individuals who received educational counseling, those who carried a pocket alarm device, those who received both, and those who received neither intervention. Participants in this study were followed for 18 months. Any participant who missed a clinic appointment by more than 4 weeks were traced and if they were unable to be contacted were defined as loss to follow-up or LTFU. This study compares the reasons for LTFU as either (1) transfered care to another facility or (2) dropped out of care. Family members or alternative contacts were interview to help categorize the reason for LTFU.
Of 393 enrolled participants, total LTFU was 83 or 21% and we were able to successfully trace and interview 75. Thirty-seven (49%) were alive at tracing and 22 (59%) of these reported having transferred their antiretroviral care. Individuals who transferred care were more likely to be women, achieved higher than primary education, and had higher salaried employement. Overall, the most common reason for LTFU was moving residence, predominantly due to job loss or change in employment. Interventions targeting men and considering mobility due to employment may improve retention in urban African HIV treatment clinics.