Loss of HIV-infected patients on potent antiretroviral therapy programs in Togo: risk factors and the fate of these patients

Abstract

Introduction: National programs are facing challenges of loss to follow-up of people living with HIV/AIDS (PLWHA) on antiretroviral therapy (ART). We sought to identify risk factors associated with early loss to follow-up among HIV-infected patients on ART in Togo and the outcome of such patients.

Methods: This was a retrospective cross-sectional study using medical records of all patients older than age 15 years enrolled at 28 treatment centers who were on ART programs and who were lost to follow-up from 2008 to 2011.

Results: Of the 16,617 patients on ART, 1,216 (7.3%) were lost to follow-up. Most (94.1%) were infected with HIV-1 and 32.6% were in WHO stage III or IV. The median CD4 count was 118/mm3 (IQR: 58-178 cells/mm3). No telephone number was mentioned in the medical records of 212 patients. Of the 1004 patients whose phone number was listed, 802 patients (79.9%) were not reachable on the recorded number, 114 patients (11.4%) were alive and 88 patients (8.8%) had died. In multivariate analysis, factors associated with loss to follow-up during the first 6 months of ART were: age below 35 years (OR=1.6; 95%CI: 1.2-2.2), female sex (OR=1.8; 95%CI: 1.3-2.5), WHO stage III or IV (OR=1.7; 95%CI: 1.3-2.2), existence of an opportunistic infection (OR=2.3; 95%CI: 1.5-3.1), and follow-up in a public centre (OR=1.9; 95%CI: 1.2-3.3).

Conclusion: This study identified several factors associated with lost to follow-up during the first 6 months of ART, and confirmed high mortality among these patients. The National AIDS Program should strengthen medical support of PLWHA in Togo including active case follow-up.

Key words: Africa, HIV, human immunodeficiency virus, lost to follow-up, people living with HIV, Togo