Influence of gender on loss to follow-up in a large HIV treatment programme in western Kenya

• Published in: Bulletin of the World Health Organization 2010-09, Vol.88 (9), p.681-688
• Main Authors: OCHIENG-OOKO, Vincent, OCHIENG, Daniel, SIDLE, John E, HOLDSWORTH, Margaret, WOOLS-KALOUSTIAN, Kara, SIIKA, Abraham M, YIANNOUTSOS, Constantin T, OWITI, Michael, KIMAIYO, Sylvester, BRAITSTEIN, Paula
• Format: Article
• Language: English
• Subjects: Acquired immune deficiency syndrome; Adult; Adults; Age; AIDS; Anti-Retroviral Agents - administration & dosage; Anti-Retroviral Agents - therapeutic use; Biological and medical sciences; Carts; Drug therapy; Female; Gender; General aspects; HIV; HIV Infections - drug therapy; HIV Infections - epidemiology; Human immunodeficiency virus; Human viral diseases; Humans; Immune system; Incidence; Infections; Infectious diseases; Kenya; Lost to Follow-Up; Lymphocytes; Male; Medical sciences; Men; Middle Aged; Miscellaneous; Patients; Position (location); Public health. Hygiene; Public health. Hygiene-occupational medicine; Retention; Retrospective Studies; Risk; Risk Factors; Sex Factors; Sociodemographics; Socioeconomic Factors; Time Factors; Variables; Viral diseases; Viral diseases of the lymphoid tissue and the blood. Aids
• ISSN: 0042-9686; 1564-0604
• DOI: 10.2471/BLT.09.064329

To determine the incidence of loss to follow-up in a treatment programme for people living with human immunodeficiency virus (HIV) infection in Kenya and to investigate how loss to follow-up is affected by gender. Between November 2001 and November 2007, 50 275 HIV-positive individuals aged ≥ 14 years (69% female; median age: 36.2 years) were enrolled in the study. An individual was lost to follow-up when absent from the HIV treatment clinic for > 3 months if on combination antiretroviral therapy (cART) or for > 6 months if not. The incidence of loss to follow-up was calculated using Kaplan-Meier methods and factors associated with loss to follow-up were identified by logistic and Cox multivariate regression analysis. Overall, 8% of individuals attended no follow-up visits, and 54% of them were lost to follow-up. The overall incidence of loss to follow-up was 25.1 per 100 person-years. Among the 92% who attended at least one follow-up visit, the incidence of loss to follow-up before and after starting cART was 27.2 and 14.0 per 100 person-years, respectively. Baseline factors associated with loss to follow-up included younger age, a long travel time to the clinic, patient disclosure of positive HIV status, high CD4+ lymphocyte count, advanced-stage HIV disease, and rural clinic location. Men were at an increased risk overall and before and after starting cART. The risk of being lost to follow-up was high, particularly before starting cART. Men were more likely to become lost to follow-up, even after adjusting for baseline sociodemographic and clinical characteristics. Interventions designed for men and women separately could improve retention.