Drop-out of medical follow-up among people living with HIV in Tel-Aviv area

ABSTRACT

Access to HIV anti-retroviral treatment (ART) has significantly improved survival and the quality of life of people living with HIV (PLHIV). However, effective therapy necessitates high adherence to ART. The aim of this study was to identify the extent to which PLHIV in Israel were not retained in therapy and their obstacles to accessing care. The Department of Tuberculosis and AIDS (DTA) and the two existing HIV clinics in the Tel-Aviv metropolitan area performed a retrospective study for all PLHIV who were consulted at these clinics during 2008–2011, but were absent in 2012. From that population, 25% were randomly chosen for qualitative interviews. This study included 278 PLHIV not retained in care (13.4% of registered patients), of whom 194 (69.8%) were male, and 58.3% were Israeli citizens. Total number of clinic visits was 1959 (mean: 7.05 visits per patient; range: 1–39; SD: ±7.2) and the total person-years of follow-up for 267 PLHIV was 1,044 (mean: 3.9 py; 0–23; SD: ±4.4). Identified risk groups were: Originating from Generalized Epidemic countries (43.5%, 82.6% were non-Israelis); Men having Sex with Men (22.6%); Injecting Drug Users (12.9%) and Others (28.9%). Among Israelis, major reasons for clinic nonattendance included distance to the clinics and perceived lack of time. The major impediment to seeking care among undocumented migrants was lack of medical insurance. The DTA acted swiftly to make HIV-related services accessible to undocumented migrants. Barriers described by Israeli participants were generally more individual in nature, and should be addressed at the clinic level.

KEYWORDS:

• HIV care
• antiretroviral therapy
• adherence
• access to healthcare
• Israel
• loss to follow-up

Acknowledgments

We would like to thank Ms. Zehuvit Wiexelbaum, from the Department of Tuberculosis and AIDS, for her excellent data management of the HIV/AIDS National Registry. We would like also to thank all the team of the DTA and of each HIV centers for their dedicated work. Many thanks to Ms. Neta Harel for their contribution in an early draft of this article, and to Ms. Jordan Hannink Attal for her proofreading and editing.

Disclosure statement

No potential conflict of interest was reported by the author(s).