Characteristics of antiretroviral therapy-naïve patients lost-to-care in HIV clinics in Democratic Republic of Congo, Cameroon, and Burundi

ABSTRACT

Antiretroviral therapy (ART)-naïve patients are vulnerable to becoming lost-to-care (LTC) because they are not monitored as often as patients on treatment. We examined data from 19,461 HIV positive adults at 10 HIV clinics in Democratic Republic of Congo (DRC), Cameroon, and Burundi participating in the Phase 1 International epidemiologic Databases to Evaluate AIDS Central Africa (IeDEA-CA) study. Patients were LTC if they were ART-naïve and did not return within 7 months of the end of data collection. Logistic regression was used to obtain odds ratios (ORs) and 95% confidence intervals (CIs) for risk factors associated with LTC. Of 5353 ART-naïve patients, 4420 (83%) were LTC and 933 (17%) were in-care. The odds of being LTC were greatest among patients from DRC (OR = 2.16, CI: 1.64–2.84, p < .0001), males (OR = 1.39, CI: 1.15–1.69, p = .0009), and ages 18–49 (OR = 1.45, CI: 1.16–1.82, p = .001). The odds of being LTC were least among patients with a WHO Clinical Stage of 1 or 2 (OR = 0.65, CI: 0.55–0.77, p < .0001) and in a perceived concordant relationship (OR = 0.61, CI: 0.43–0.87, p < .0001). LTC patients were more likely to have characteristics associated with higher risk for HIV transmission and progression. Many entered care at advanced stages and were less likely to know their partner’s serostatus. Greater efforts to retain ART-naïve patients may increase earlier initiation of ART.

KEYWORDS:

• ART-naïve
• lost-to-care
• Central Africa
• HIV

Acknowledgements

The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. The International epidemiologic Databases to Evaluate AIDS (IeDEA) Central Africa region collaboration acknowledge the contribution of local staff and patients in this project and Dr Robin Huebner of NIAID.

Disclosure statement

No potential conflict of interest was reported by the authors.

Additional information

Funding

This work was supported by the National Institutes of Health (NIH)/National Institutes of Allergy and Infectious Disease (NIAID) [grant number U01AI069927].