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Publication Details
AFRICAN RESEARCH NEXUS
SHINING A SPOTLIGHT ON AFRICAN RESEARCH
immunology and microbiology
Early loss to follow up after enrolment in pre-ART care at a large public clinic in Johannesburg, South Africa
Tropical Medicine and International Health, Volume 15, No. SUPPL. 1, Year 2010
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Description
Objective To estimate loss to follow up (LTFU) between initial enrolment and the first scheduled return medical visit of a pre-antiretroviral therapy (ART) care program for patients not eligible for ART. Methods The study was conducted at a public-sector HIV clinic in Johannesburg. We reviewed records of all patients newly enrolled in the pre-ART care program and not yet eligible for ART between January 2007 and February 2008. Crude proportions of patients completing their first return medical visit stratified by patient characteristics were calculated. A modified-Poisson approach was used to estimate directly relative risks of returning for their first return medical visit within 1 year adjusting for patient characteristics as potential confounders. Results A total of 356 patients were identified. Two-thirds had a CD4 count > 350 cells/μl (median [IQR] CD4 = 458 [394, 585]) and were scheduled to return in 6 months for a first medical visit. Seventy-four percent of these patients did not return within one year for this visit. The remaining 36% of all patients had a baseline CD4 count 251-350 cells/μl and were scheduled to return in 3 months. Only 6% of these patients returned within 4 months; 41% returned within one year. Relative risks were positively associated with a patient being employed and negatively associated with the baseline CD4 count. Conclusions Given the high rate of LTFU immediately after enroling in pre-ART care, it is clear that care programs are not expediting the timely initiation of ART. Significantly improved adherence to pre-ART care and monitoring for patients not yet eligible for ART is required for South Africa to achieve its AIDS strategy goals and reduce the problem of late presentation and initiation of ART. © 2010 Blackwell Publishing Ltd.
Authors & Co-Authors
Larson, Bruce A.
United States, Boston
School of Public Health
Brennan, Alana T.
United States, Boston
School of Public Health
McNamara, Lynne
South Africa, Johannesburg
University of the Witwatersrand
Long, Lawrence C.
South Africa, Johannesburg
University of the Witwatersrand
Rosen, Sydney B.
United States, Boston
School of Public Health
Sanne, Ian
South Africa, Johannesburg
University of the Witwatersrand
Fox, Matthew P.
United States, Boston
School of Public Health
Statistics
Citations: 118
Authors: 7
Affiliations: 2
Identifiers
Doi:
10.1111/j.1365-3156.2010.02511.x
ISSN:
13602276
e-ISSN:
13653156
Research Areas
Health System And Policy
Infectious Diseases
Study Locations
South Africa