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Male, Mobile, and Moneyed: Loss to Follow-Up vs. Transfer of Care in an Urban African Antiretroviral Treatment Clinic

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Listed:
  • Kara G Marson
  • Kenneth Tapia
  • Pamela Kohler
  • Christine J McGrath
  • Grace C John-Stewart
  • Barbra A Richardson
  • Julia W Njoroge
  • James N Kiarie
  • Samah R Sakr
  • Michael H Chung

Abstract

Objectives: The purpose of this study was to analyze characteristics, reasons for transferring, and reasons for discontinuing care among patients defined as lost to follow-up (LTFU) from an antiretroviral therapy (ART) clinic in Nairobi, Kenya. Design: The study used a prospective cohort of patients who participated in a randomized, controlled ART adherence trial between 2006 and 2008. Methods: Participants were followed from pre-ART clinic enrollment to 18 months after ART initiation, and were defined as LTFU if they failed to return to clinic 4 weeks after their last scheduled visit. Reasons for loss were captured through phone call or home visit. Characteristics of LTFU who transferred care and LTFU who did not transfer were compared to those who remained in clinic using log-binomial regression to estimate risk ratios. Results: Of 393 enrolled participants, total attrition was 83 (21%), of whom 75 (90%) were successfully traced. Thirty-seven (49%) were alive at tracing and 22 (59%) of these reported having transferred their antiretroviral care. In the final model, transfers were more likely to have salaried employment [Risk Ratio (RR), 2.7; 95% confidence interval (CI), 1.2-6.1; p=0.020)] and pay a higher monthly rent (RR, 5.8; 95% CI, 1.3-25.0; p=0.018) compared to those retained in clinic. LTFU who did not transfer care were three times as likely to be men (RR, 3.1; 95% CI, 1.1-8.1; p=0.028) and nearly 4 times as likely to have a primary education or less (RR, 3.8; 95% CI, 1.3-10.6; p=0.013). Overall, the most common reason for LTFU was moving residence, predominantly due to job loss or change in employment. Conclusion: A broad definition of LTFU may include those who have transferred their antiretroviral care and thereby overestimate negative effects on ART continuation. Interventions targeting men and considering mobility due to employment may improve retention in urban African ART clinics. Clinical Trials: The study’s ClinicalTrials.gov identifier is NCT00273780.

Suggested Citation

  • Kara G Marson & Kenneth Tapia & Pamela Kohler & Christine J McGrath & Grace C John-Stewart & Barbra A Richardson & Julia W Njoroge & James N Kiarie & Samah R Sakr & Michael H Chung, 2013. "Male, Mobile, and Moneyed: Loss to Follow-Up vs. Transfer of Care in an Urban African Antiretroviral Treatment Clinic," PLOS ONE, Public Library of Science, vol. 8(10), pages 1-1, October.
    • Handle: RePEc:plo:pone00:0078900
    DOI: 10.1371/journal.pone.0078900
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    References listed on IDEAS

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    1. Catherine Linard & Marius Gilbert & Robert W Snow & Abdisalan M Noor & Andrew J Tatem, 2012. "Population Distribution, Settlement Patterns and Accessibility across Africa in 2010," PLOS ONE, Public Library of Science, vol. 7(2), pages 1-8, February.
    2. Martin W G Brinkhof & Mar Pujades-Rodriguez & Matthias Egger, 2009. "Mortality of Patients Lost to Follow-Up in Antiretroviral Treatment Programmes in Resource-Limited Settings: Systematic Review and Meta-Analysis," PLOS ONE, Public Library of Science, vol. 4(6), pages 1-9, June.
    3. Jane Fortson, 2008. "The gradient in sub-saharan Africa: Socioeconomic status and HIV/AIDS," Demography, Springer;Population Association of America (PAA), vol. 45(2), pages 303-322, May.
    4. Bigsten, Arne, 1996. "The Circular Migration of Smallholders in Kenya," Journal of African Economies, Centre for the Study of African Economies, vol. 5(1), pages 1-20, March.
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    1. Rachel A Silverman & Grace C John-Stewart & Ingrid A Beck & Ross Milne & Catherine Kiptinness & Christine J McGrath & Barbra A Richardson & Bhavna Chohan & Samah R Sakr & Lisa M Frenkel & Michael H Ch, 2019. "Predictors of mortality within the first year of initiating antiretroviral therapy in urban and rural Kenya: A prospective cohort study," PLOS ONE, Public Library of Science, vol. 14(10), pages 1-19, October.

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