Abstract

WEAE0203 - Oral Abstract Session

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. Weigel<sup>3,4

1</sup>Liverpool 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.