Abstract:
Background. Most evaluations of loss to follow-up (LTFU) in human immunodeficiency virus (HIV) treatment
programs focus on baseline predictors, prior to antiretroviral therapy (ART) initiation. As risk of LTFU is a continuous
issue, the aim of this evaluation was to augment existing information with further examination of time-dependent
predictors of loss.
Methods. This was a retrospective evaluation of data collected between 2004 and 2012 by the Harvard School of
Public Health and the AIDS Prevention Initiative in Nigeria as part of PEPFAR-funded program in Nigeria. We used
multivariate modeling methods to examine associations between CD4+ cell counts, viral load, and early adherence patterns
with LTFU, defined as no refills collected for at least 2 months since the last scheduled appointment.
Results. Of 51 953 patients initiated on ART between 2004 and 2011, 14 626 (28%) were LTFU by 2012. Factors
associated with increased risk for LTFU were young age, having nonincome-generating occupations or no education,
being unmarried,World Health Organization (WHO) stage, having a detectable viral load, and lower CD4+ cell counts.
In a subset analysis, adherence patterns during the first 3months of ART were associated with risk of LTFU bymonth 12.
Conclusions. In settings with limited resources, early adherence patterns, as well as CD4+ cell counts and unsuppressed
viral load, at any time point in treatment are predictive of loss and serve as effective markers for developing
targeted interventions to reduce rates of attrition.
