Wang, BingxiaLosina, ElenaStark, RuthMunro, AlisonWalensky, Rochelle P.Wilke, MarisaMartin, Desmond J.Lu, ZhigangFreedberg, Kenneth A.Wood, Robin2011-05-062011-05-062011-04Wang, 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 ]2078-5135http://hdl.handle.net/2263/16493BACKGROUND: 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.enHealth and Medical Publishing GroupCommunity clinicsSouth AfricaLoss to follow-up (LTFU)Antiretroviral therapy (ART)Antiretroviral agents -- South AfricaArticle