The predictors of loss to follow
up among HIV positive patients
attending a Bali Clinic; a
longitudinal Study
Desak Nym Widyanthini
Background
•
HIV was first reported from in Indonesia in 1987 and the
number of reported cases continues to increase
•
Between 1987 and December 2012 Bali has reported a total
of 9724 cases
•
Bali ranks 5
thafter Jakarta, East Java, Papua, and West Java in
the number of HIV cases
•
Antiretroviral Therapy (ART) is now available to reduce
mortality and morbidity and improve quality of life for people
living with HIV
•
Successful ART depends on regular and complete patient
follow-up
•
The number of new patients starting ART and the number lost
to follow-up are important indicators of program effectiveness
Aims and Objective
•
To determine the factors that predict loss to
follow up of HIV patient
Method
•
A longitudinal analysis of medical records of HIV patients
attending a clinic between 2002 and December 2012
•
Study site: YKP
–
a non government clinic for high risk
groups located in Denpasar
•
Population: high risk groups with a positive HIV test
result
•
Inclusion criteria: patients starting ART for the first time
in YKP Clinic.
•
Exclusion criteria: patients who die, move away, or only
one time visit YKP
•
Analysis method: survival analysis based on time to
follow up or time to loss
Preliminary Result
Total population = 545 people
•
68 (12.5%) people was die
•
45 (8.3%) people move away
•
1 (0.2%) people only one time visit YKP
•
80 (14.7%) people lost to follow up
•
351 (64.4%) people no lost to follow up
Data Description (n=431)
Variable n (%)
Sex •Man •Woman 237 (55%) 194 (45%) Occupation •Other
•Sex workers
•Missing
323(75.9%) 107 (24.8%) 1 (0.23%) Risk of HIV transmission
•IDU •Homosexual •Heterosexual •Bisexual 88 (20% 75 (17%) 254 (59%) 14 (3%) Education
•Senior high school
•Junior high school
•No education, elementary
201 (47%) 93 (22%) 137 (32%)
OI
•Do ’t have •Have
371 (86%) 60 (14%)
Variable n (%)
Supervisor of ARV
•Have
•Do ’t have 281 (65%) 150 (35%) Age
•≤ 7 yr •<27-31 yr
•>31-36 yr
•<36 yr
141 (33%) 104 (24%) 85 (20%) 101 (23%) CD4 cell
•≤ sel/
•> 300sel/mm3
383 (89%) 48 (11%) Hemoglobin
•≤ gr%
•>12-13.7 gr%
•>13.7 gr%
•missing 124 (29%) 165 (38%) 135 (31%) 7 (2%) Weight
•≤5 kg •>51-59 kg
•>59 kg
•missing
Univariate Analysis :
Multivariate Analysis* :
* Adjusted from sex, supervisor of ART, age, cd4 cell, hemoglobin, and weight
Characteristic Haz. Ratio L95%CI U95%CI P P-group
risk of HIV transmission IDU ref
homosexual 3.14 1.42 6.93 0.005 heterosexual 2.71 1.4 5.23 0.003
bisexual 5.79 1.59 21.09 0.008 0.007 education senior high school ref
junior high school 1.86 1.05 3.3 0.032
no education, elementary 1.99 1.18 3.35 0.009 0.022 supervisor of ART have ref
do ’t have 1.76 1.11 2.78 0.016
Characteristic Haz. Ratio L95%CI U95%CI P P-group
risk of HIV transmission IDU ref
homosexual 3.13 1.41 6.92 0.005 heterosexual 2.34 1.2 4.57 0.012
bisexual 6.97 2 25.74 0.004 0.007 education senior high school ref
junior high school 1.82 1.01 3.28 0.045
Preliminary Conclusion
The predictors of Lost to Follow Up are :
1. Risk of HIV transmission
2. Education
Implementation :
Concern to related factor that influence the
Next Steps
Acknowledgement
•
Mentors from Kirby Institute
