Background: 

Undetermined attrition prohibits full understanding of the coverage and effectiveness of HIV programs. Outcomes following loss to follow-up (LTFU) among antiretroviral therapy (ART) patients may differ according to their reasons for ART initiation.

Setting: 

We compare the true outcomes of adult patients previously identified as LTFU by reason for ART initiation in 8 health facilities in north eastern South Africa.

Methods: 

Adult HIV patient records were linked to health and demographic surveillance system (HDSS) data from 2014 to 2017. Outcomes of adults categorized as LTFU (>90 days late for the last scheduled clinic visit) were determined through clinic and routine tracing record reviews, consultation of HDSS data, and supplementary tracing. We calculated the proportion of patients per outcome category and performed competing risk survival analysis to estimate the cumulative incidence of death, transfer, migration, ART interruption, and re-engagement following LTFU.

Results: 

Of 895/1017 patients LTFU with an outcome ascertained, 120 (13.4%) had died, 225 (25.1%) re-engaged, 50 (5.6%) migrated out of the HDSS, 75 (8.4%) were alive and not on treatment, and 315 (35.1%) transferred their treatment. These outcomes varied by sex and pregnancy status at ART initiation. Mortality was less likely among pregnant women, patients with higher baseline CD4, and more likely among older patients.

Conclusions: 

Patient survival and transfers to other facilities are considerably higher than those suggested in earlier studies. Outcomes differ for women who were pregnant or postpartum when initiating ART, with this population less likely to have died and more likely to have migrated.

中文翻译：

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与南非农村地区的一般艾滋病治疗人群相比，孕妇和产后妇女失去跟进检查后的结果

背景： 

无法确定的人员流失使人们无法充分了解艾滋病毒项目的覆盖面和有效性。抗逆转录病毒疗法（ART）患者中失去随访（LTFU）后的结果可能因其开始ART的原因而有所不同。

设置： 

我们比较了在南非东北部的8个卫生机构中因接受抗逆转录病毒疗法而被鉴定为LTFU的成年患者的真实结果。

方法： 

成人HIV患者记录与2014年至2017年的健康和人口统计学监测系统（HDSS）数据相关。归类为LTFU（上一次预定的就诊晚于90天）的成人结果是通过诊所和常规追踪记录审查，咨询来确定的HDSS数据和补充跟踪。我们计算了每种结局类别的患者比例，并进行了竞争风险生存分析，以评估LTFU后死亡，转移，迁移，ART中断和重新参与的累积发生率。

结果： 

在确定结果的895/1017 LTFU患者中，有120名（13.4％）死亡，225名（25.1％）再次参与，有50名（5.6％）从HDSS移出，有75名（8.4％）活着并且未接受治疗，而315名（35.1％）转移了治疗。在开始抗逆转录病毒治疗时，这些结果因性别和怀孕状况而异。孕妇，基线CD4较高的患者死亡率较低，而老年患者则较高。

结论： 

患者的存活率和转移到其他机构的费用大大高于早期研究的建议。对于开始接受抗逆转录病毒疗法的孕妇或产后的结果有所不同，该人群死亡的可能性较小，而移徙的可能性较大。