Loss to Follow-Up Among Adults Attending Human Immunodeficiency Virus Services in England, Wales, and Northern Ireland

• Published in: Sexually transmitted diseases 2011-08, Vol.38 (8), p.685-690
• Main Authors: Rice, Brian D., Delpech, Valerie C., Chadborn, Timothy R., Elford, Jonathan
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Adults; Antiretroviral Therapy, Highly Active; Biological and medical sciences; Cohort Studies; Cross-Sectional Studies; England; England - epidemiology; Epidemiology. Vaccinations; Ethnic Groups - statistics & numerical data; Ethnicity; Female; General aspects; Health services; HIV; HIV Infections - drug therapy; HIV Infections - epidemiology; HIV Infections - ethnology; Human immunodeficiency virus; Human infectious diseases. Experimental studies and models; Human viral diseases; Humans; Infectious diseases; Lost to Follow-Up; Male; Medical diagnosis; Medical sciences; Northern Ireland; Northern Ireland - epidemiology; Original Study; Polls & surveys; Viral diseases; Viral diseases of the lymphoid tissue and the blood. Aids; Wales; Wales - epidemiology; Young Adult
• ISSN: 0148-5717; 1537-4521
• DOI: 10.1097/OLQ.0b013e318214b92e

Aim: To assess the extent to which human immunodeficiency virus (HIV)-diagnosed adults attending HIV-services in England, Wales, and Northern Ireland are lost to follow-up or attend services intermittently. Methods: A cohort of HIV-diagnosed adults was created by linking records across the 1998 to 2007 national annual Survey of Prevalent HIV Infections Diagnosed. The records were also linked to the national HIV and acquired immune deficiency syndrome New Diagnoses Database (n = 61,495) and to Office for National Statistics death records. Patterns of HIV-service attendance were analyzed. Results: On average, 90% of adults attending HIV-services in any one year attended the following year. Nearly 5% of adults attending services in any one year were lost to follow-up, a further 4% subsequently attended services intermittently, whereas less than 2% died. Cumulatively, 19% of adults seen for HIV care between 1998 and 2006 were lost to follow-up by the end of 2007. Factors associated with loss to follow-up included being the following: female; aged 15 to 34 years; black-African or "other" ethnicity; not on antiretroviral therapy; recently diagnosed; and infected outside the United Kingdom. Conclusions: Although the majority of HIV-diagnosed adults in England, Wales, and Northern Ireland attended HIV-services regularly, cumulatively nearly 1 in 5 adults were lost to follow-up between 1998 and 2007. Innovative strategies focusing on those most likely to drop out of regular care should be developed to maintain regular service engagement and to ensure optimal care.