Risk Factors for Loss to Follow-Up among People Who Inject Drugs in a Risk Reduction Program at Karachi, Pakistan
INTRODUCTION:
Retention
of male people who inject drugs (PWIDs) is a major challenge for harm reduction
programs that include sterile needle/syringe exchange in resource-limited
settings like Pakistan. We assessed the risk factors for loss to follow-up
among male PWIDs enrolled in a risk reduction program in Karachi, Pakistan.
METHODS:
We
conducted a prospective cohort study among 636 HIV-uninfected male PWIDs
enrolled during March-June 2009 in a harm reduction program for the estimation
of incidence rate. At 24 months post-enrollment, clients who had dropped out of
the program were defined as lost to follow-up and included as cases for
case-cohort study.
RESULTS:
The
median age of the participants was 29 years (interquartile range: 23-36).
Active outreach accounted for 76% (483/636) of cohort recruits. Loss to
follow-up at 24 months was 25.5% (162/636). In multivariable logistic
regression, younger age (AOR: 0.97, 95% CI: 0.92-0.99, p = 0.028), clients from
other provinces than Sindh (AOR: 1.49, 95% CI: 1.01-2.22, p = 0.046), having no
formal education (AOR: 3.44, 95% CI: 2.35-4.90, p<0.001), a history of
incarceration (AOR: 1.68, 95% CI: 1.14-2.46, p<0.008), and being homeless
(AOR: 1.47, 95% CI: 1.00-2.19, p<0.049) were associated with loss to
follow-up.
CONCLUSIONS:
Our
cohort retained 74.5% of male PWIDs in Karachi for 24 months. Its loss to
follow up rate suggested substantial ongoing programmatic challenges.
Programmatic enhancements are needed for the highest risk male PWIDs, i.e.,
younger men, men not from Sindh Province, men who are poorly educated, formerly
incarcerated, and/or homeless.
- 1Polio Eradication Initiative, World Health Organization, Larkana, Pakistan.
- 2Department of Community Health Sciences, Aga Khan University, Karachi, Pakistan.
- 3Bridge Consultants Foundation, Karachi, Pakistan.
- 4Sindh AIDS Control Program, Karachi, Pakistan.
- 5Vanderbilt Institute for Global Health & Department of Biostatistics, Vanderbilt University School of Medicine, Nashville, Tennessee, United States of America.
- 6Vanderbilt Institute for Global Health & Department of Medicine, Vanderbilt University School of Medicine, Nashville, Tennessee, United States of America.
- 7Vanderbilt Institute for Global Health & Department of Pediatrics, Vanderbilt University School of Medicine, Nashville, Tennessee, United States of America.
- PLoS One. 2016 Feb 3;11(2):e0147912. doi: 10.1371/journal.pone.0147912. eCollection 2016.
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