dc.contributor.author |
Wang, Bingxia
|
|
dc.contributor.author |
Losina, Elena
|
|
dc.contributor.author |
Stark, Ruth
|
|
dc.contributor.author |
Munro, Alison
|
|
dc.contributor.author |
Walensky, Rochelle P.
|
|
dc.contributor.author |
Wilke, Marisa
|
|
dc.contributor.author |
Martin, Desmond J.
|
|
dc.contributor.author |
Lu, Zhigang
|
|
dc.contributor.author |
Freedberg, Kenneth A.
|
|
dc.contributor.author |
Wood, Robin
|
|
dc.date.accessioned |
2011-05-06T07:49:04Z |
|
dc.date.available |
2011-05-06T07:49:04Z |
|
dc.date.issued |
2011-04 |
|
dc.description.abstract |
BACKGROUND: Faith-based organisations have expanded antiretroviral therapy (ART) in community clinics across South Africa. Loss to follow-up (LTFU), however, limits the potential individual and
population treatment benefits and optimal care.
OBJECTIVE: To identify patient characteristics associated with
LTFU 6 months after starting ART in a large community clinic.
METHODS: Patients initiating ART between April 2004 and October 2006 in one South African Catholic Bishops’ Conference HIV treatment clinic who had at least one follow-up visit were included and routinely monitored every 6 months after ART
initiation. Standardised instruments were used to collect data. Rates of LTFU over time were estimated by the Kaplan-Meier method.
The Cox proportional hazard regression examined the impact of age, baseline CD4 count, baseline HIV RNA, gender and pregnancy
status on LTFU.
RESULTS: Data from 925 patients (age >14 years, median age 36 years, 70% female, of whom 16% were pregnant) were included: 51
(6%) were lost to follow-up 6 months after ART initiation. Younger age (≤30 years) (hazard ratio (HR) 2.14, 95% confidence interval (CI) 1.05 - 4.38) and pregnancy for women (HR 3.75, 95% CI 1.53 - 9.16) were significantly associated with higher LTFU rates. When stratified by baseline CD4 count, gender and pregnancy status, pregnant women with lower baseline CD4 counts (≤200 cells/μl) had 6.06 times the hazard (95% CI 2.20 - 16.71) of LTFU at 6 months compared with men.
CONCLUSIONS: HIV-infected pregnant women initiating ART were significantly more likely to be lost to follow-up in a community
clinic in South Africa. Urgent interventions to successfully retain pregnant women in care are needed. |
en_US |
dc.identifier.citation |
Wang, B, Losina, E, Stark, R, Munro, A, Walensky, RP, Wilke, M, Martin, D, Lu, Z, Freedberg, KA & Wood, R 2011, 'Loss to follow-up in a community clinic in South Africa – roles of gender, pregnancy and CD4 count', South African Medical Journal, vol. 101, no. 4, pp. 253-257. [http://www.samj.org.za ] |
en_US |
dc.identifier.issn |
2078-5135 |
|
dc.identifier.uri |
http://hdl.handle.net/2263/16493 |
|
dc.language.iso |
en |
en_US |
dc.publisher |
Health and Medical Publishing Group |
en_US |
dc.rights |
Health and Medical Publishing Group |
en_US |
dc.subject |
Community clinics |
en_US |
dc.subject |
South Africa |
en_US |
dc.subject |
Loss to follow-up (LTFU) |
en_US |
dc.subject |
Antiretroviral therapy (ART) |
en_US |
dc.subject.lcsh |
Antiretroviral agents -- South Africa |
en |
dc.title |
Loss to follow-up in a community clinic in South Africa – roles of gender, pregnancy and CD4 count |
en_US |
dc.type |
Article |
en_US |