Assessing factors for loss to follow-up of HIV infected patients in Guinea-Bissau
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The objective of this study was to ascertain vital status of patients considered lost to follow-up at an HIV clinic in Guinea-Bissau, and describe reasons for loss to follow-up (LTFU).
This study was a cross-sectional sample of a prospective cohort, carried out between May 15, 2013, and January 31, 2014. Patients lost to follow-up, who lived within the area of the Bandim Health Project, a demographic surveillance site (DSS), were eligible for inclusion. Active follow-up was attempted by telephone and tracing by a field assistant. Semi-structured interviews were done face to face or by phone by a field assistant and patients were asked why they had not shown up for the scheduled appointment. Patients were included by date of HIV testing and risk factors for LTFU were assessed using Cox proportional hazard model.
Among 561 patients (69.5 % HIV-1, 18.0 % HIV-2 and 12.6 % HIV-1/2) living within the DSS, 292 patients had been lost to follow-up and were, therefore, eligible for active follow-up. Vital status was ascertained in 65.9 % of eligible patients and 42.7 % were alive, while 23.2 % had died. Information on reasons for LTFU existed for 103 patients. Major reasons were moving (29.1 %), travelling (17.5 %), and transferring to other clinics (11.7 %).
A large proportion of the patients at the clinic were lost to follow-up. The main reason for this was found to be the geographic mobility of the population in Guinea-Bissau.
KeywordsHIV Loss to follow-up Retention Mortality West Africa Guinea-Bissau
The authors would like to thank the staff and patients at the HIV clinic. Special thanks to João Paulo Nanque, Joana Mendes and Quintino Lopes Ié for their work with tracing patients and to Zacarias da Silva and the laboratory staff working in the TB and HIV sections at the National Public Health Laboratory and to the office staff at the Bandim Health Project for making this study possible.
The Bissau HIV Cohort study group comprises: Amabelia Rodrigues, David da Silva, Zacarias da Silva, Candida Medina, Ines Oliviera-Souto, Lars Østergaard, Alex Laursen, Bo Hønge, Peter Aaby, Anders Fomsgaard, Christian Erikstrup, Sanne Jespersen and Christian Wejse (chair).
Funding was provided by Institut for Klinisk Medicin, and National Institutes of Health (Grant No. U01AI069919) through IeDEA.
Compliance with ethical standards
The HIV cohort at the outpatient clinic was approved by the National Ethics Committee in Guinea-Bissau in 2007 (Parecer NCP/No. 15/2007). Upon inclusion, patients sign a voluntary, informed consent, using fingerprint if illiterate. The cohort has an open approval to use data from patients’ records as long as patient confidentiality is not broken. This study was approved separately by the ethical committee in Guinea-Bissau (No. Ref. 060/CNES/INASA/2013). At all times field assistants were cautious not to disclose HIV status to anyone.
Conflict of interest
PBN has received funding from Institute of Clinical Medicine, Aarhus University, Denmark. WAPHIR and IeDEA supported data collection in Bissau. For the remaining authors none were declared.
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