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Predictors of Loss to Follow-Up in an HIV Vaccine Preparedness Study in Masaka, Uganda

Background: High participant retention is essential to achieve adequate statistical power for clinical trials. We assessed participant retention and predictors of loss to follow-up (LTFU) in an HIV vaccine-preparedness study in Masaka, Uganda. Methods: Between July 2018 and March 2021, HIV sero-nega...

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Autores principales: Kabarambi, Anita, Kansiime, Sheila, Kusemererwa, Sylvia, Kitonsa, Jonathan, Kaleebu, Pontiano, Ruzagira, Eugene
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9180097/
https://www.ncbi.nlm.nih.gov/pubmed/35681962
http://dx.doi.org/10.3390/ijerph19116377
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author Kabarambi, Anita
Kansiime, Sheila
Kusemererwa, Sylvia
Kitonsa, Jonathan
Kaleebu, Pontiano
Ruzagira, Eugene
author_facet Kabarambi, Anita
Kansiime, Sheila
Kusemererwa, Sylvia
Kitonsa, Jonathan
Kaleebu, Pontiano
Ruzagira, Eugene
author_sort Kabarambi, Anita
collection PubMed
description Background: High participant retention is essential to achieve adequate statistical power for clinical trials. We assessed participant retention and predictors of loss to follow-up (LTFU) in an HIV vaccine-preparedness study in Masaka, Uganda. Methods: Between July 2018 and March 2021, HIV sero-negative adults (18–45 years) at high risk of HIV infection were identified through HIV counselling and testing (HCT) from sex-work hotspots along the trans-African highway and fishing communities along the shores of Lake Victoria. Study procedures included collection of baseline socio-demographic data, quarterly HCT, and 6-monthly collection of sexual risk behaviour data. Retention strategies included collection of detailed locator data, short clinic visits (1–2 h), flexible reimbursement for transport costs, immediate (≤7 days) follow-up of missed visits via phone and/or home visits, and community engagement meetings. LTFU was defined as missing ≥2 sequential study visits. Poisson regression models were used to identify baseline factors associated with LTFU. Results: 672 participants were included in this analysis. Of these, 336 (50%) were female and 390 (58%) were ≤24 years. The median follow-up time was 11 months (range: 0–31 months). A total 214 (32%) participants were LTFU over 607.8 person-years of observation (PYO), a rate of 35.2/100 PYO. LTFU was higher in younger participants (18–24 years versus 35–45 years, adjusted rate ratio (aRR) = 1.29, 95% confidence interval (CI) 0.80–2.11), although this difference was not significant. Female sex (aRR = 2.07, 95% CI, 1.51–2.84), and recreational drug use (aRR = 1.61, 95% CI, 1.12–2.34) were significantly associated with increased LTFU. Engagement in transactional sex was associated with increased LTFU (aRR = 1.36, 95% CI, 0.97–1.90) but this difference was not significant. LTFU was higher in 2020–2021 (the period of COVID-19 restrictions) compared to 2018–2019 (aRR = 1.54, 1.17–2.03). Being Muslim or other (aRR = 0.68, 95% CI 0.47–0.97) and self-identification as a sex worker (aRR = 0.47, 95% CI, 0.31–0.72) were associated with reduced LTFU. Conclusion: We observed a high LTFU rate in this cohort. LTFU was highest among women, younger persons, recreational drug users, and persons who engage in transactional sex. Efforts to design retention strategies should focus on these subpopulations.
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spelling pubmed-91800972022-06-10 Predictors of Loss to Follow-Up in an HIV Vaccine Preparedness Study in Masaka, Uganda Kabarambi, Anita Kansiime, Sheila Kusemererwa, Sylvia Kitonsa, Jonathan Kaleebu, Pontiano Ruzagira, Eugene Int J Environ Res Public Health Review Background: High participant retention is essential to achieve adequate statistical power for clinical trials. We assessed participant retention and predictors of loss to follow-up (LTFU) in an HIV vaccine-preparedness study in Masaka, Uganda. Methods: Between July 2018 and March 2021, HIV sero-negative adults (18–45 years) at high risk of HIV infection were identified through HIV counselling and testing (HCT) from sex-work hotspots along the trans-African highway and fishing communities along the shores of Lake Victoria. Study procedures included collection of baseline socio-demographic data, quarterly HCT, and 6-monthly collection of sexual risk behaviour data. Retention strategies included collection of detailed locator data, short clinic visits (1–2 h), flexible reimbursement for transport costs, immediate (≤7 days) follow-up of missed visits via phone and/or home visits, and community engagement meetings. LTFU was defined as missing ≥2 sequential study visits. Poisson regression models were used to identify baseline factors associated with LTFU. Results: 672 participants were included in this analysis. Of these, 336 (50%) were female and 390 (58%) were ≤24 years. The median follow-up time was 11 months (range: 0–31 months). A total 214 (32%) participants were LTFU over 607.8 person-years of observation (PYO), a rate of 35.2/100 PYO. LTFU was higher in younger participants (18–24 years versus 35–45 years, adjusted rate ratio (aRR) = 1.29, 95% confidence interval (CI) 0.80–2.11), although this difference was not significant. Female sex (aRR = 2.07, 95% CI, 1.51–2.84), and recreational drug use (aRR = 1.61, 95% CI, 1.12–2.34) were significantly associated with increased LTFU. Engagement in transactional sex was associated with increased LTFU (aRR = 1.36, 95% CI, 0.97–1.90) but this difference was not significant. LTFU was higher in 2020–2021 (the period of COVID-19 restrictions) compared to 2018–2019 (aRR = 1.54, 1.17–2.03). Being Muslim or other (aRR = 0.68, 95% CI 0.47–0.97) and self-identification as a sex worker (aRR = 0.47, 95% CI, 0.31–0.72) were associated with reduced LTFU. Conclusion: We observed a high LTFU rate in this cohort. LTFU was highest among women, younger persons, recreational drug users, and persons who engage in transactional sex. Efforts to design retention strategies should focus on these subpopulations. MDPI 2022-05-24 /pmc/articles/PMC9180097/ /pubmed/35681962 http://dx.doi.org/10.3390/ijerph19116377 Text en © 2022 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
spellingShingle Review
Kabarambi, Anita
Kansiime, Sheila
Kusemererwa, Sylvia
Kitonsa, Jonathan
Kaleebu, Pontiano
Ruzagira, Eugene
Predictors of Loss to Follow-Up in an HIV Vaccine Preparedness Study in Masaka, Uganda
title Predictors of Loss to Follow-Up in an HIV Vaccine Preparedness Study in Masaka, Uganda
title_full Predictors of Loss to Follow-Up in an HIV Vaccine Preparedness Study in Masaka, Uganda
title_fullStr Predictors of Loss to Follow-Up in an HIV Vaccine Preparedness Study in Masaka, Uganda
title_full_unstemmed Predictors of Loss to Follow-Up in an HIV Vaccine Preparedness Study in Masaka, Uganda
title_short Predictors of Loss to Follow-Up in an HIV Vaccine Preparedness Study in Masaka, Uganda
title_sort predictors of loss to follow-up in an hiv vaccine preparedness study in masaka, uganda
topic Review
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9180097/
https://www.ncbi.nlm.nih.gov/pubmed/35681962
http://dx.doi.org/10.3390/ijerph19116377
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