abstract: 'Despite progress on population-level HIV viral suppression, unknown

  outcomes amongst people who have initiated antiretroviral therapy (ART)

  in low- and middle-income countries, commonly referred to as loss to

  follow-up (LTFU), remains a barrier. The mean global estimate of LTFU is

  20\%, exceeding the World Health Organization target of <15\%. Pervasive

  predictors associated with LTFU include younger age, low body mass

  index, low CD4 count, advanced HIV clinical stage and certain ART

  regimens. In Namibia, ART use by eligible individuals exceeds 85\%,

  surpassing the global average. Nonetheless, LTFU remains a barrier to

  achieving viral suppression and requires research to elucidate

  context-specific factors. An observational cohort study was conducted in

  Namibia in 2012 by administering surveys to individuals who presented

  for HIV care and initiated ART for the first time. Additional data were

  collected from routine medical data monitoring systems. Participants

  classified as LTFU at 12 months were traced to confirm their status.

  Predictors of LTFU were analyzed using multivariable logistic

  regression. Of those who presented consecutively to initiate ART, 524

  were identified as eligible to enroll in the study, 497 enrolled, and

  474 completed the baseline questionnaire. The cohort had mean age 36

  years, 39\% were male, mean CD4 cell count 222 cells/mm3, 17\% were WHO

  HIV clinical stage and 14\% started efavirenz-based regimens. Tracing

  participants classified as LTFU yielded a re-categorization from 27.8\%

  (n = 132) to 14.3\% (n = 68) LTFU. In the final multivariable model,

  factors associated with confirmed LTFU status were: younger age (OR

  0.97, 95\% CI 1.00-1.06, p = 0.02); male sex (OR 2.34, CI 1.34-4.06, p =

  0.003); difficulty leaving work or home to attend clinic (OR 2.55, CI

  1.40-4.65, p = 0.002); and baseline efavirenz-based regimen (OR 2.35, CI

  1.22-4.51, p = 0.01). Interventions to reduce LTFU should therefore

  target young men, particularly those who report difficulty leaving work

  or home to attend clinic and are on an efavirenz-based regimen.'
affiliation: 'Hong, SY (Corresponding Author), Tufts Med Ctr, Div Geog Med \& Infect
  Dis, Boston, MA 02111 USA.

  Hong, SY (Corresponding Author), Tufts Univ, Sch Med, Dept Publ Hlth \& Community
  Med, Boston, MA 02111 USA.

  Hong, Steven Y.; Wanke, Christine; Jordan, Michael R., Tufts Med Ctr, Div Geog Med
  \& Infect Dis, Boston, MA 02111 USA.

  Hong, Steven Y.; Roy, Tuhin; Wanke, Christine; Tang, Alice M.; Jordan, Michael R.,
  Tufts Univ, Sch Med, Dept Publ Hlth \& Community Med, Boston, MA 02111 USA.

  Winston, Anna, Hosp Univ Penn, 3400 Spruce St, Philadelphia, PA 19104 USA.

  Mutenda, Nicholus; Hamunime, Ndapewa, Republ Namibia Minist Hlth \& Social Serv,
  Directorate Special Programmes, Windhoek, Namibia.'
article-number: e0266438
author: Hong, Steven Y. and Winston, Anna and Mutenda, Nicholus and Hamunime, Ndapewa
  and Roy, Tuhin and Wanke, Christine and Tang, Alice M. and Jordan, Michael R.
author-email: shong@tuftsmedicalcenter.org
author_list:
- family: Hong
  given: Steven Y.
- family: Winston
  given: Anna
- family: Mutenda
  given: Nicholus
- family: Hamunime
  given: Ndapewa
- family: Roy
  given: Tuhin
- family: Wanke
  given: Christine
- family: Tang
  given: Alice M.
- family: Jordan
  given: Michael R.
da: '2023-09-28'
doi: 10.1371/journal.pone.0266438
files: []
issn: 1932-6203
journal: PLOS ONE
keywords-plus: 'SUB-SAHARAN AFRICA; INFECTED PATIENTS; DRUG-RESISTANCE; ADULT PATIENTS;

  SCALING-UP; OUTCOMES; INITIATION; EXPERIENCE; RETENTION; EFAVIRENZ'
language: English
number: '4'
number-of-cited-references: '40'
orcid-numbers: Hong, Steven/0000-0002-2149-5132
papis_id: edcb4c5e0fd33c5d4f52daa7a8851cfe
ref: Hong2022predictorsloss
times-cited: '1'
title: Predictors of loss to follow-up from HIV antiretroviral therapy in Namibia
type: Article
unique-id: WOS:000795453600047
usage-count-last-180-days: '0'
usage-count-since-2013: '0'
volume: '17'
web-of-science-categories: Multidisciplinary Sciences
year: '2022'