We investigated factors associated with loss to follow-up (LTFU) in 24 urban health facilities in Nairobi, Kenya. We conducted a retrospective analysis of routinely collected data to assess factors associated with LTFU in the period October 1, 2016, to June 30, 2017. LTFU was defined as no antiretroviral therapy (ART) refill for ≥90 days and no documentation of transfer, death, or treatment cessation in the patient chart, and if no lapse of ≥90 days between ART refills, patients were considered retained in care. Multivariable logistic regression modeling was used to compute odds ratios and 95% confidence interval (CI) for LTFU. Our analysis included 633 individuals who were LTFU and 13,098 individuals retained in care. Most participants (69.6%) were women, and median age was 33.0 years (interquartile range, 27.2–38.3 years). Median ART duration was shorter among those LTFU (0.4 years) than retained patients (2.5 years, p < .0001). Being male [adjusted odds ratio (aOR) 1.30; 95% CI: 1.04–1.63, p = .02], transferring into facilities while already receiving ART (aOR 11.58; 95% CI: 8.23–16.29, p < .0001), and having a shorter ART duration (<6 months) were associated with increased odds of LTFU. Patients who transferred into a facility while already receiving ART had the highest adjusted odds of being LTFU compared with those retained in care. In this urban and highly mobile population, transferring into facilities while already receiving ART was strongly associated with LTFU. Focusing programming efforts on patients transferring between urban clinics to identify reasons for transfer and potential barriers to treatment adherence could help improve patient outcomes. Supplementary case management and support may be needed to promote a seamless transition and ensure uninterrupted engagement in HIV care and treatment.

中文翻译：

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与肯尼亚内罗毕接受 HIV 治疗的患者失访相关的因素

我们在肯尼亚内罗毕的 24 个城市卫生机构中调查了与失访 (LTFU) 相关的因素。我们对常规收集的数据进行了回顾性分析，以评估 2016 年 10 月 1 日至 2017 年 6 月 30 日期间与 LTFU 相关的因素。 LTFU 被定义为≥90 天没有抗逆转录病毒疗法 (ART) 补充剂且无转移记录，死亡或患者图表中的治疗停止，并且如果 ART 再填充之间没有间隔 ≥ 90 天，则认为患者继续接受治疗。多变量逻辑回归模型用于计算 LTFU 的优势比和 95% 置信区间 (CI)。我们的分析包括 633 名 LTFU 患者和 13,098 名留守患者。大多数参与者 (69.6%) 是女性，中位年龄为 33.0 岁（四分位距，27.2-38.3 岁）。p  < .0001）。作为男性 [调整优势比 (aOR) 1.30；95% CI：1.04–1.63，p  = .02]，在已经接受 ART 的同时转入设施（aOR 11.58；95% CI：8.23–16.29，p < .0001），并且具有较短的 ART 持续时间（<6 个月）与 LTFU 的几率增加有关。与继续接受 ART 的患者相比，在已经接受 ART 的情况下转入医疗机构的患者调整后患 LTFU 的几率最高。在这个城市和高度流动的人口中，在已经接受 ART 的同时转入设施与 LTFU 密切相关。将规划工作重点放在在城市诊所之间转移的患者上，以确定转移的原因和治疗依从性的潜在障碍，可能有助于改善患者的治疗效果。可能需要补充病例管理和支持以促进无缝过渡并确保不间断地参与艾滋病毒护理和治疗。