Abstract:
Losses to follow-up (LTFU) remain an important programmatic challenge. While numerous
patient-level factors have been associated with LTFU, less is known about facility-level fac-
tors. Data from the East African International epidemiologic Databases to Evaluate AIDS
(EA-IeDEA) Consortium was used to identify facility-level factors associated with LTFU in
Kenya, Tanzania and Uganda. Patients were defined as LTFU if they had no visit within 12
months of the study endpoint for pre-ART patients or 6 months for patients on ART. Adjust-
ing for patient factors, shared frailty proportional hazard models were used to identify the
facility-level factors associated with LTFU for the pre- and post-ART periods. Data from
77,362 patients and 29 facilities were analyzed. Median age at enrolment was 36.0 years
(Interquartile Range: 30.1, 43.1), 63.9% were women and 58.3% initiated ART. Rates (95%
Confidence Interval) of LTFU were 25.1 (24.7
–
25.6) and 16.7 (16.3
–
17.2) per 100 person-
years in the pre-ART and post-ART periods, respectively. Facility-level factors associated
with increased LTFU included secondary-level care, HIV RNA PCR turnaround time
>
14
days, and no onsite availability of CD4 testing. Increased LTFU was also observed when no
nutritional supplements were provided (pre-ART only), when TB patients were treated within
the HIV program (pre-ART only), and when the facility was open
4 mornings per week(ART only). Our findings suggest that facility-based strategies such as point of care labora-
tory testing and separate clinic spaces for TB patients may improve retention.
