Incidence and predictors of early loss to follow up among patients initiated on protease inhibitor-based second-line antiretroviral therapy in southwestern Uganda
Date
2021-03-20Author
Nuwagira, Edwin
Lumori1, Boniface A. E
Muhindo1, Rose
Kanyesigye, Michael
Amir, Abdallah
Muyindike, Winnie
Muzoora, Conrad
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Background: Good adherence to antiretroviral therapy (ART) and retention in care are essential for the efectiveness of an HIV care program. With the current increase in numbers of people living with HIV taking second-line ART
in sub-Saharan Africa, there is a need to establish their treatment outcomes and the rate of loss to follow up. In this
study, we determined the incidence and predictors of loss to follow up among patients taking second-line ART at an
experienced HIV treatment center in southwestern Uganda.
Methods: This was a retrospective review of an electronic database at Mbarara Regional Referral Hospital HIV clinic in
southwestern Uganda. Second-line ART included at least two of the nucleoside reverse transcriptase inhibitors and a
boosted protease inhibitor. Loss to follow-up was defned as failure to return to the health facility for care or treatment
refll for 180 days or more from the previous visit. After excluding children less than 15 years, we pooled data that
included socio-demographic, clinical, and laboratory data for patients who started second-line ART between 2002
and 2017. Multiple imputation was done for variables with missing data. Variables that had a p<0.05 in unadjusted
bivariate analyses were included in a multivariate binomial regression model using a stepwise backward selection
procedure to describe the factors that independently predicted loss to follow-up.
Results: Between 2002 and 2017, 1121 patients had been initiated on second-line ART. We included data from 924
participants and of these, 518 (56.1%) were female, the mean age (SD) was 38.4 (±10.5) years, and 433 (52.4%) had
a CD4 count less than 100 cells/µl at the start of second-line ART. The incidence of loss to follow-up was 26.7 per
100 person-years. Male gender (Adjusted risk ratio (ARR)=1.8, 95% CI 1.5–2.0) p<0.001 and anemia ARR 1.4, 95% CI
1.1–1.6) p<0.001 were strongly associated with loss to follow up.
Conclusions: There is a high incidence of loss to follow up among patients taking protease-inhibitor based secondline ART at a tertiary HIV center in southwestern Uganda. There is a need to routinely measure hemoglobin during
clinic reviews, and establish mechanisms to retain males initiated on second-line ART in care. The association of anemia and loss to follow up needs to be investigated
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