Predictors of Lost-to-follow-up Among People Living With HIV Receiving Antiretroviral Therapy in Nyarugenge District, City of Kigali, Rwanda
Background: Lost to follow-up (LTFUP) continues to threaten the sustainability of antiretroviral therapy (ART) benefits and success of ART programs. We aimed to determine the incidence and predictors of LTFUP among HIV patients on ART in Nyarugenge District, Kigali City.
Methods: A retrospective cohort of people living with HIV (PLHIV) who initiated ART in 2018 was conducted for 24 months. Using health facility records, a person who had no record of contact with the health facility for 3 consecutive months was considered LTFUP. LTFUP incidence rates were computed, and Cox-proportional hazard rate ratios calculated to determine factors associated with time to first LTFUP event. Generalized estimating equations were used to analyze repeated measurement outcomes of LTFUP and predictors of LTFUP.
Results: Of 950 participants, 581 (61.2%) were females and 866 (91.2%) were 15–49 years old. For 19,033 person months of observation (pmo), 148 participants got LTFUP for 551 times. The incidence rate to first event was 7.8 per 1,000 pmo (95% CI=6.6–9.1) and 26.5 per 1,000 pmo (95% CI=24.2–28.7) to multiple events. WHO stage was only associated with time to first event but marital status, employment status, and person of contact were associated with both first and repeated LTFUP. The rate of repeated LTFUP was higher among participants with a contact person who was not a community health worker (CHW) or a peer educator (aIRR=2.69; 95% CI=1.43–5.06), single patients compared to married/co-habiting (aIRR=1.74; 95% CI=1.28–2.34), and self-employed compared to employed participants (aIRR=1.51; 95% CI=1.14–2.01). PLHIV living out of the health facility catchment area (aIRR=1.55; 95% CI=1.19–2.01) and children initiated on first line (aIRR=0.43; 95% CI=0.21–0.86) compared to adults, were only associated with repeated LTFUP.
Conclusions: CHW and peer educators can help to reduce LTFUP while targeted sensitization is needed for single, self-employed patients and those living out of the health facility catchment area.