Predictors of Loss to Follow‑up Among HIV‑infected Patients in a Rural South‑Eastern Nigeria Hospital: A 5‑year Retrospective Cohort Study

Abstract

Background: Patient attrition has been a challenge in managing HIV programs in resource‑limited settings. Aim: This study reviews the predictors of loss to follow‑up (LTFU) in our hospital and suggests the best practices for dealing with the issue. Subjects and
Methods: A 5‑year retrospective cohort study of 1256 HIV‑infected patients. Baseline CD4 counts, age, gender, year of enrolment, and antiretroviral therapy combination regimen were considered in this study. Kaplan–Meier models were used to estimate the univariate time‑to‑LTFU and Cox proportional hazards models to identify the multivariate predictors of LTFU.
Results: Twenty‑four percent (23.9% [301/1256]) of patients were lost to follow‑up. Baseline CD4 count, year of enrolment, and drug combination were significant predictors of LTFU. Patients enrolled earlier (2008/2009) were twice as likely to be LTFU compared with those enrolled later (2010–2013). Gender and age did not significantly predict LTFU nor confound other predictors.
Conclusion: The program showed higher LTFU rates than most studies in Nigeria and Africa, maybe due to difficulties with the access to the hospital and possible treatment fatigue. This study recommends the provision of transportation subsidies and proactive patient follow‑up with “peer‑tracking” to reduce LTFU among HIV infected patients, especially in resource‑limited settings.

Keywords: Cohort studies, HIV infections, Loss to‑follow‑up, Nigeria, Transportation