WEAE0203 - Oral Abstract
Risk factors and true outcomes of children lost to follow-up from antiretroviral therapy in Lilongwe, Malawi
Presented by Hannock Tweya (Malawi).
C. Ardura Garcia1, H. Tweya2, C. Feldacker2, S. Phiri2, R. Weigel3,4
1Liverpool School of Topical Medicine, Liverpool, United Kingdom, 2Lighthouse Trust Clinic, Kamuzu Central Hospital, Lilongwe, Malawi, 3Liverpool School of Topical Medicine, Disease Control Strategy Group, Liverpool, United Kingdom, 4Lighthouse Trust, Kamuzu Central Hospital, Lilongwe, Malawi
Background: Loss to follow-up (LTFU)
negatively affects antiretroviral therapy (ART) programmes by leading to viral
resistance as well as immunological and clinical failure among patients and by
biasing mortality estimates. Among children, risk factors for LTFU and true
outcomes of these patients are not well known. The objectives of the study were
to analyze LTFU risk factors of children on ART and to determine their true
outcomes through active tracing.
Methods: Descriptive retrospective cohort study of 1182
children that were on ART at an urban HIV clinic in Malawi between April 2006
and December 2010. Since 2006, the clinic implements an innovative programme,
Back-to-Care (B2C), to increase ART patient retention through phone and field
tracking. Baseline characteristics routinely collected at ART initiation were
gathered together with the information obtained from the B2C field tracing team
to determine ART initiation factors that influenced subsequent LTFU.
Results: Of 985 children (1999 children-years) on ART
included in the analysis, 251 (25%) were LTFU, a LTFU rate of 12.6/100
children-years. No available CD4 count at initiation [Adjusted Hazard Ratio (AHR):
2.01, 95% CI: 1.31-3.07]; nutritional wasting (AHR: 1.6, 95% CI: 1.17-2.18) and
age under 2 years (AHR: 1.55, 95% CI: 1.02-2.37) all independently increased the
risk of LTFU. Of 201 LTFU children traced, 158 (79%) were found: 11% died, 26%
transferred out (TO) to another treatment centre and 63% were alive. LTFU rate
was reduced by 62% after tracing. Mortality estimates were corrected, increasing
from 2.6% to 4.8%.
Conclusions: Increased patient retention efforts, coupled
with more active tracing of LTFU children on ART, could reduce LTFU, increase
patient adherence, and improve mortality rate estimates.
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