Missing Scheduled Visits in the Outpatient Clinic as a Marker of Short-Term Admissions and Death (original) (raw)
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Predictors of Mortality among Patients Lost to Follow up Antiretroviral Therapy
Jurnal Ners, 2018
Introduction: The death of HIV/AIDS patients after receiving therapy in Bali is the seventh highest percentage of deaths in Indonesia. LTFU increases the risk of death in PLHA, given the saturation of people with HIV taking medication. The level of consistency in the treatment is very important to maintain the resilience and quality of life of people living with HIV. This study aims to determine the incidence rate, median time and predictors of death occurring in LTFU patients as seen from their sociodemographic and clinical characteristics. Methods: This study used an analytical longitudinal approach with retrospective secondary data analysis in a cohort of HIV-positive patients receiving ARV therapy at the Buleleng District Hospital in the period 2006-2015. The study used the survival analysis available within the STATA SE 12 software Results: The result showed that the incidence rate of death in LTFU patients was 65.9 per 100 persons, with the median time occurrence of 0.2 years (2.53 months). The NNRTI-class antiretroviral evapirens agents were shown to increase the risk of incidence of death in LTFU patients 3.92 times greater than the nevirapine group (HR 3.92; p = 0.007 (CI 1.46-10.51). Each 1 kg increase in body weight decreased the risk of death in LTFU patients by 6% (HR 0.94; p = 0.035 (CI 0.89-0.99). Conclusion: An evaluation and the monitoring of patient tracking with LTFU should be undertaken to improve sustainability. Furthermore, an observation of the LTFU patient's final condition with primary data and qualitative rese
JAIDS Journal of Acquired Immune Deficiency Syndromes, 2008
Background: A significant proportion of those initiating antiretroviral treatment (ART) for HIV infection are lost to follow-up. Causes for discontinuing ART follow-up in resource-limited settings are not well understood. Methods: A retrospective analysis was conducted of all adult patients receiving ART at an urban public clinic in Johannesburg, South Africa between April 2004 and June 2005. Patients discontinuing follow-up for at least 6 weeks were identified and further studied, and causes for treatment default were tabulated. Results: Of 1631 adult patients studied, 267 (16.4%) discontinued follow-up during the study period. Gender, ethnicity, and age were not predictive of loss to follow-up. Of those discontinuing follow-up, 173 (64.8%) were successfully traced. Death accounted for 48% (n = 83) of those traced. Characteristics associated with death were older age at ART initiation (P = 0.022), lower baseline CD4 cell count (P = 0.0073), higher initial HIV RNA load (P = 0.024), and loss of weight on ART (P = 0.033). Date of death was known for 71% (n = 59) of patients traced deceased, of whom 83% (n = 49) had died within 30 days of active ART. Common nonmortality losses included relocation or clinic transfer (25.4%) and hospitalization or illness not resulting in death (10.4%). Few cited financial difficulty or medication toxicity as reasons for discontinuing follow-up. Conclusions: Nearly 1 in 6 patients receiving ART in a resourceconstrained setting had discontinued follow-up over a 15-month period. Early mortality was high, especially in those with profound immunosuppression. Improving access to care and streamlining patient tracking may improve ART outcomes.
Journal of evolution of medical and dental sciences, 2014
Importance: With increasing number of persons living with Human Immunodeficiency Virus (HIV) in major cities there is a need to have a comprehensive strategy to reduce the number of drop outs from the anti-retroviral (ART) therapy. This can be done effectively only when we study the reasons why patients are lost to follow up. This study has brought to light novel causes of nonadherence to ART, like migration, discordance and resort to alternative therapies. DESIGN: This is a qualitative study conducted at ART Center, Byramjee Jeejeebhoy Medical College (BJMC) and Sassoon General Hospital (SGH), Pune, a tertiary referral center in India. We included all those patients who were initiated antiretroviral therapy and lost to follow-up (LFU) any time during the entire month after three months during which the appointment was scheduled. All these patients were interviewed during restart of ART, in ART center, BJMC and SGH. MAIN OUTCOMES AND MEASURES: All sociodemographic and clinical factors associated with antiretroviral therapy adherence. RESULTS: Out of a total 51patients lost to follow-up, patients above thirty five years of age and male sex were associated with a higher chance of being lost to LFU. Illiteracy rate was high in age group above 35 years (64.1%) and in females. Male drivers were lost to follow-up at a greater extent [14(24.75%)]. Out of 24(47.06%) married patients, 12(50%) male patients were sero-discordant. The chance of defaulting from therapy was high in the first three months and one year later from the initiation of therapy. Migration led to drop out of 13(25.49%) patients. Other important factors leading to loss to follow up were: death in family, side effects of drugs and family disturbance. Alcoholism was the cause in 23(45.10%) male patients. CONCLUSION AND RELEVANCE: Migration, illiteracy, alcoholism, discordant couples, death in family, low socioeconomic status, resorting to alternative therapies were the prominent factors which directly influenced and aggravated the problem of nonadherence. Targeting these variables will cause definite reduction in lost to follow-up cases.
BMC Health Services Research, 2015
Background: The number of Human Immunodeficiency Virus (HIV) infected people eligible for initiation on antiretroviral Therapy (ART) is increasing. ART programmatic success requires that patients who are taking ART remain on treatment and are followed up regularly. This study investigated factors associated with being lost to follow-up, in a cohort of patients enrolled in a pharmacovigilance study in South Africa. Methods: This was a retrospective observational cohort study performed at one of the Medunsa National Pharmacovigilance Centre's (MNPC) ART sentinel surveillance sites. Loss to Follow-up (LTFU) was defined as "a patient who had been followed up at the sentinel site, who had not had contact with the health facility for 180 days or more since their last recorded expected date of return or if there were 180 days or more between the expected date of return and the next clinic visit". Results: Out of 595 patients, 65.5 % (n = 390) were female and 23.4 % (n = 139) were LTFU. The median time on ART before LTFU was 21.5 months (interquartile range: 12.9-34.7 months). The incidence rate of LTFU was 103 per 1000 person-years in the first year on ART and increased to 405 per 1000 person-years in the eighth year of taking ART. Factors associated with becoming LTFU included not having a committed partner (Adjusted Hazard Ratio (aHR): 2.9, 95 % Confidence Interval (CI):1.19-6.97, p = 0.019), being self-employed (aHR: 13.9, 95 % CI:2.81-69.06, p = 0.001), baseline CD4 count > 200 cells/ml (aHR: 3.8, 95 % CI: 1.85-7.85, p < 0.001), detectable last known Viral Load (VL) (aHR: 3.6, 95 % CI:1.98-6.52, p < 0.001) and a last known World Health Organisation clinical stage three or four (aHR: 2.0, 95 % CI:1.22-3.27, p = 0.006). Patients that previously had an ART adverse event had a lower risk (aHR: 0.6, 95 % CI: 0.38-0.99, p = 0.044) of becoming LTFU than those that had not. Conclusion: The incidence rate of LTFU increases with additional years on ART. Intensified measures to improve patient retention on ART must be prioritised with increasing patient time on ART and in patients that are at increased risk of becoming lost to follow-up.
JAIDS Journal of Acquired Immune Deficiency Syndromes, 2015
In resource-limited settings, early mortality on antiretroviral therapy (ART) is approximately 10%; yet, it is unclear how much of that mortality occurs in care or after lost to follow-up. We assessed mortality rates and predictors of death among 12,222 nonpregnant ART-naive adults initiating first-line ART between April 2004 and May 2012 in South Africa, stratified by person-years in care and lost. We found 14.6% of patients died and being lost accounted for a minority of deaths across multiple definitions of loss (population attributable-risk percent ranged from 10.4% to 42.5%). Although mortality rates in patients lost were much higher than in care, most ART-related mortality occurred on treatment.
Loss to Followup in HIV-Infected Patients from Asia-Pacific Region: Results from TAHOD
AIDS Research and Treatment, 2012
This study examined characteristics of HIV-infected patients in the TREAT Asia HIV Observational Database who were lost to follow-up (LTFU) from treatment and care. Time from last clinic visit to 31 March 2009 was analysed to determine the interval that best classified LTFU. Patients defined as LTFU were then categorised into permanently LTFU (never returned) and temporary LTFU (re-entered later), and these groups compared. A total of 3626 patients were included (71% male). No clinic visits for 180 days was the best-performing LTFU definition (sensitivity 90.6%, specificity 92.3%). During 7697 person-years of follow-up, 1648 episodes of LFTU were recorded (21.4 per 100-person-years). Patients LFTU were younger (P = 0.002), had HIV viral load ≥500 copies/mL or missing (P = 0.021), had shorter history of HIV infection (P = 0.048), and received no, single-or doubleantiretroviral therapy, or a triple-drug regimen containing a protease inhibitor (P < 0.001). 48% of patients LTFU never returned. These patients were more likely to have low or missing haemoglobin (P < 0.001), missing recent HIV viral load (P < 0.001), negative hepatitis C test (P = 0.025), and previous temporary LTFU episodes (P < 0.001). Our analyses suggest that patients not seen at a clinic for 180 days are at high risk of permanent LTFU, and should be aggressively traced.
Journal of the International AIDS Society, 2012
Introduction: Clinical outcome is an important determinant of programme success. This study aims to evaluate patients' baseline characteristics as well as level of care associated with lost to follow-up (LTFU) and mortality of patients on antiretroviral treatment (ART). Methods: Retrospective cohort study using routine service data of adult patients initiated on ART in 2007 in 10 selected hospitals in Nigeria. We captured data using an electronic medical record system and analyzed using Stata. Outcome measures were probability of being alive and retained in care at 12, 24 and 36 months on ART. Potential predictors associated with time to mortality and time to LTFU were assessed using competing risks regression models. Results: After 12 months on therapy, 85% of patients were alive and on ART. Survival decreased to 81.2% and 76.1% at 24 and 36 months, respectively. Median CD4 count for patients at ART start, 12, 18 and 24 months were 152 (interquartile range, IQR: 75 to 242), 312 (IQR: 194 to 450), 344 (IQR: 227 to 501) and 372 (IQR: 246 to 517) cells/ml, respectively. Competing risk regression showed that patients' baseline characteristics significantly associated with LTFU were male (adjusted sub-hazard ratio, sHR 01.24 [95% CI: 1.08 to 1.42]), ambulatory functional status (adjusted sHR01.25 [95% CI: 1.01 to 1.54]), World Health Organization (WHO) clinical Stage II (adjusted sHR01.31 [95% CI: 1.08 to 1.59]) and care in a secondary site (adjusted sHR 00.76 [95% CI: 0.66 to 0.87]). Those associated with mortality include CD4 count B50 cells/ml (adjusted sHR02.84 [95% CI: 1.20 to 6.71]), WHO clinical Stage III (adjusted sHR 02.67 [95% CI: 1.26 to 5.65]) and Stage IV (adjusted sHR 05.04 [95% CI: 1.93 to 13.16]) and care in a secondary site (adjusted sHR02.21 [95% CI: 1.30 to 3.77]).
Compound Retention in Care and All-Cause Mortality among People Living with HIV
Open Forum Infectious Diseases
Background. To obtain optimal health outcomes, persons living with human immunodeficiency virus (HIV) must be retained in clinical care. We examined the relationships between 4 possible combinations of 2 separate retention measures (missed visits and the Institute of Medicine [IOM] indicator) and all-cause mortality. Methods. The sample included 4162 antiretroviral therapy (ART)-naive patients who started ART between January 2000 and July 2010 at any of 5 US sites of the Center for AIDS Research Network of Integrated Clinical Systems. The independent variable of interest was retention, captured over the 12-month period after the initiation of ART. The study outcome, all-cause mortality 1 year after ART initiation, was determined by querying the Social Security Death Index or the National Death Index. We evaluated the associations of the 4 categories of retention with all-cause mortality, using the Cox proportional hazards models. Results. Ten percent of patients did not meet retention standards for either measure (hazard ratio [HR], 2.26; 95% confidence interval [CI], 1.59-3.21). Patients retained by the IOM but not the missed-visits measure (42%) had a higher HR for mortality (1.72; 95% CI, 1.33-2.21) than patients retained by both measures (41%). Patients retained by the missed-visits but not the IOM measure (6%) had the same mortality hazards as patients retained by both measures (HR, 1.01; 95% CI, .54-1.87). Conclusions. Missed visits within the first 12 months of ART initiation are a major risk factor for subsequent death. Incorporating missed visits in clinical and public health retention and viral suppression programming is advised.