The Majority of the Pre-Antiretroviral Population Who Were Lost to Follow-Up Stopped Their Care in Freetown, Sierra Leone
BACKGROUND:
The
heterogeneity of the pre-antiretroviral (pre-ART) population calls for more
granular depictions of the cascade of HIV care.
METHODS:
We
studied a prospective cohort of persons newly diagnosed with HIV infection from
a single center in Freetown, Sierra Leone, over a 12-month period and then
traced those persons who were lost to follow-up (LTFU) during pre-ART care
(before ART initiation). ART eligibility was based on a CD4 cell count result
of ≤ 350 mm/cells and/or WHO clinical stage 3 or 4. Persons who attended an
appointment in the final three months were considered to be retained in care.
Adherence to ART was measured using pharmacy refill dates. "Effective HIV
care" was defined as completion of the cascade of care at 12-months
regardless of whether patients are on ART. Tracing outcomes were obtained for
those who were LTFU during pre-ART care.
RESULTS:
408
persons newly diagnosed with HIV infection were screened, 338 were enrolled,
and 255 persons were staged for ART. ART-ineligible persons had higher
retention rates than ART-eligible persons (59.6% vs 41.8%, p = 0.03). 77
(22.8%) of 338 persons received effective HIV care. Most attrition (61.9%)
occurred with persons during pre-ART care. 123 of 138 persons (89.1%) who were
LTFU prior to ART initiation were found, and 91 of those 123 (74.0%) were
alive. Of the 74 persons who were alive and described their engagement in care,
40 (54.1%) stopped care. Nearly half (42.5%) of those 40 stopped after
assessment of ART-eligibility but before ART initiation. The main limitation of
this study was the lack of tracing outcomes for those lost during ART care.
CONCLUSIONS:
The
majority of the pre-ART LTFU population stopped their care, particularly after
ART-eligibility but before ART initiation. Interventions to hasten ART
initiation and retain this at-risk group may have significant downstream impact
on effective HIV care.
Below: Cascade of care for newly diagnosed persons to receive effective HIV care
- 1Department of Medicine, Baylor College of Medicine, Houston, Texas, United States of America.
- 2Wellbody Alliance, Koidu Town, Sierra Leone.
- 3National HIV/AIDS Secretariat, Freetown, Sierra Leone.
- 4College of Medicine and Allied Health Sciences of University of Sierra Leone, Freetown, Sierra Leone.
- PLoS One. 2016 Feb 22;11(2):e0149584. doi: 10.1371/journal.pone.0149584. eCollection 2016.
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