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Background: World health organisation (WHO) currently recommends all people diagnosed HIV positive to start antiretroviral therapy instantly (T&T) regardless of CD4 cell count and WHO stage. Currently however, a myriad of HIV treatment programs are plagued with the challenge of patients'' loss to follow up. We set out to study factors associated with loss to follow up (LTFU) in a primary healthcare facility practising T&T.
Methods: We retrospectively drew and analysed a sample of patients from routine patients'' data for HIV clients enrolled into HIV care from January 2012 to December 2014 at Masaka regional referral hospital -Uganda Cares clinic. We defined loss to follow up as failure of the client to show up at the Masaka clinic for at least 91 days from the date of their last appointment taking 31st December 2014 as the reference. We determined cumulative incidence of loss to follow up at differing time intervals and used multivariable cox proportional hazards regression model to determine factors associated with time to LTFU.
Results: We included 600 patients in the sample, 64.7% were females and the median (IQR) age at enrollment of 30.4 (23.8-37.1). The median (IQR) CD4 cell count at start of ART was 373 (204-570), and 15.2% were in WHO stage 3 or 4. By 31st December 2014, 55 cases of LTFU were observed, and the cumulative incidence of LTFU was 8.48% (95% CI=6.26-11.12) at 12 months into HIV care. In multivariable analysis, T&T (aHR=2.49, 95% CI=1.07-5.78), WHO stage 3&4 (aHR=3.78, 95% CI=1.70-8.41) TB suspect (aHR=3.42, 95% CI=1.19-9.81) were associated with an elevated risk of LTFU; whereas access to mobile phone (aHR=0.56, 95% CI=0.36-0.88) duration on ART 1-3 months (aHR=0.21, 95% CI=0.08-0.59), 3-6 months (aHR=0.03, 95% CI=0.01-0.11) and ≥6months (aHR=0.003, 95% CI=0.001-0.01) were independently associated with reduced risk of LTFU.
Conclusions: This study identified testing and initiating on ART instantly being associated with elevated risk of LTFU and as well TB suspicion and advanced disease at enrolment. In a bid to achieve the 90-90-90 campaign therefore, steep ART initiation should be backed by intensive pre-initiation and adherence counseling for better long term retention of patients.