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Loss to follow-up and opportunities for reengagement in HIV care in rural Mozambique: A prospective cohort study
Patients lost to follow-up (LTFU) over the human immunodeficiency virus (HIV) cascade have poor clinical outcomes and contribute to onward HIV transmission. We assessed true care outcomes and factors associated with successful reengagement in patients LTFU in southern Mozambique. Newly diagnosed HIV...
Autores principales: | , , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Wolters Kluwer Health
2020
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7254184/ https://www.ncbi.nlm.nih.gov/pubmed/32443358 http://dx.doi.org/10.1097/MD.0000000000020236 |
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author | Fuente-Soro, Laura López-Varela, Elisa Augusto, Orvalho Bernardo, Edson Luis Sacoor, Charfudin Nhacolo, Ariel Ruiz-Castillo, Paula Alfredo, Charity Karajeanes, Esmeralda Vaz, Paula Naniche, Denise |
author_facet | Fuente-Soro, Laura López-Varela, Elisa Augusto, Orvalho Bernardo, Edson Luis Sacoor, Charfudin Nhacolo, Ariel Ruiz-Castillo, Paula Alfredo, Charity Karajeanes, Esmeralda Vaz, Paula Naniche, Denise |
author_sort | Fuente-Soro, Laura |
collection | PubMed |
description | Patients lost to follow-up (LTFU) over the human immunodeficiency virus (HIV) cascade have poor clinical outcomes and contribute to onward HIV transmission. We assessed true care outcomes and factors associated with successful reengagement in patients LTFU in southern Mozambique. Newly diagnosed HIV-positive adults were consecutively recruited in the Manhiça District. Patients LTFU within 12 months after HIV diagnosis were visited at home from June 2015 to July 2016 and interviewed for ascertainment of outcomes and reasons for LTFU. Factors associated with reengagement in care within 90 days after the home visit were analyzed by Cox proportional hazards model. Among 1122 newly HIV-diagnosed adults, 691 (61.6%) were identified as LTFU. Of those, 557 (80.6%) were approached at their homes and 321 (57.6%) found at home. Over 50% had died or migrated, 10% had been misclassified as LTFU, and 252 (78.5%) were interviewed. Following the visit, 79 (31.3%) reengaged in care. Having registered in care and a shorter time between LTFU and visit were associated with reengagement in multivariate analyses: adjusted hazards ratio of 3.54 [95% confidence interval (CI): 1.81–6.92; P < .001] and 0.93 (95% CI: 0.87–1.00; P = .045), respectively. The most frequently reported barriers were the lack of trust in the HIV-diagnosis, the perception of being in good health, and fear of being badly treated by health personnel and differed by type of LTFU. Estimates of LTFU in rural areas of sub-Saharan Africa are likely to be overestimated in the absence of active tracing strategies. Home visits are resource-intensive but useful strategies for reengagement for at least one-third of LTFU patients when applied in the context of differentiated care for those LTFU individuals who had already enrolled in HIV care at some point. |
format | Online Article Text |
id | pubmed-7254184 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2020 |
publisher | Wolters Kluwer Health |
record_format | MEDLINE/PubMed |
spelling | pubmed-72541842020-06-15 Loss to follow-up and opportunities for reengagement in HIV care in rural Mozambique: A prospective cohort study Fuente-Soro, Laura López-Varela, Elisa Augusto, Orvalho Bernardo, Edson Luis Sacoor, Charfudin Nhacolo, Ariel Ruiz-Castillo, Paula Alfredo, Charity Karajeanes, Esmeralda Vaz, Paula Naniche, Denise Medicine (Baltimore) 4850 Patients lost to follow-up (LTFU) over the human immunodeficiency virus (HIV) cascade have poor clinical outcomes and contribute to onward HIV transmission. We assessed true care outcomes and factors associated with successful reengagement in patients LTFU in southern Mozambique. Newly diagnosed HIV-positive adults were consecutively recruited in the Manhiça District. Patients LTFU within 12 months after HIV diagnosis were visited at home from June 2015 to July 2016 and interviewed for ascertainment of outcomes and reasons for LTFU. Factors associated with reengagement in care within 90 days after the home visit were analyzed by Cox proportional hazards model. Among 1122 newly HIV-diagnosed adults, 691 (61.6%) were identified as LTFU. Of those, 557 (80.6%) were approached at their homes and 321 (57.6%) found at home. Over 50% had died or migrated, 10% had been misclassified as LTFU, and 252 (78.5%) were interviewed. Following the visit, 79 (31.3%) reengaged in care. Having registered in care and a shorter time between LTFU and visit were associated with reengagement in multivariate analyses: adjusted hazards ratio of 3.54 [95% confidence interval (CI): 1.81–6.92; P < .001] and 0.93 (95% CI: 0.87–1.00; P = .045), respectively. The most frequently reported barriers were the lack of trust in the HIV-diagnosis, the perception of being in good health, and fear of being badly treated by health personnel and differed by type of LTFU. Estimates of LTFU in rural areas of sub-Saharan Africa are likely to be overestimated in the absence of active tracing strategies. Home visits are resource-intensive but useful strategies for reengagement for at least one-third of LTFU patients when applied in the context of differentiated care for those LTFU individuals who had already enrolled in HIV care at some point. Wolters Kluwer Health 2020-05-15 /pmc/articles/PMC7254184/ /pubmed/32443358 http://dx.doi.org/10.1097/MD.0000000000020236 Text en Copyright © 2020 the Author(s). Published by Wolters Kluwer Health, Inc. http://creativecommons.org/licenses/by-nc/4.0 This is an open access article distributed under the terms of the Creative Commons Attribution-Non Commercial License 4.0 (CCBY-NC), where it is permissible to download, share, remix, transform, and buildup the work provided it is properly cited. The work cannot be used commercially without permission from the journal. http://creativecommons.org/licenses/by-nc/4.0 |
spellingShingle | 4850 Fuente-Soro, Laura López-Varela, Elisa Augusto, Orvalho Bernardo, Edson Luis Sacoor, Charfudin Nhacolo, Ariel Ruiz-Castillo, Paula Alfredo, Charity Karajeanes, Esmeralda Vaz, Paula Naniche, Denise Loss to follow-up and opportunities for reengagement in HIV care in rural Mozambique: A prospective cohort study |
title | Loss to follow-up and opportunities for reengagement in HIV care in rural Mozambique: A prospective cohort study |
title_full | Loss to follow-up and opportunities for reengagement in HIV care in rural Mozambique: A prospective cohort study |
title_fullStr | Loss to follow-up and opportunities for reengagement in HIV care in rural Mozambique: A prospective cohort study |
title_full_unstemmed | Loss to follow-up and opportunities for reengagement in HIV care in rural Mozambique: A prospective cohort study |
title_short | Loss to follow-up and opportunities for reengagement in HIV care in rural Mozambique: A prospective cohort study |
title_sort | loss to follow-up and opportunities for reengagement in hiv care in rural mozambique: a prospective cohort study |
topic | 4850 |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7254184/ https://www.ncbi.nlm.nih.gov/pubmed/32443358 http://dx.doi.org/10.1097/MD.0000000000020236 |
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