AGE, EDUCATION, RISK OF TRANSMISSION, AND SUPERVISON OF ARV AS PREDICTORS OF LOSS TO FOLLOW UP AMONG HIV/AIDS PATIENTS AT A TREATMENT CLINIC IN BALI
2002-2012
Desak Nyoman Widyanthini1, Anak Agung Sagung Sawitri1, Luh Putu Lila Wulandari1, Partha Muliawan1, Yuneti Oktavianus Nyoko1 , Kathy Petoumenos2, Janaki Amin2, Bradley Mathers2, John
Kaldor2, Dewa Nyoman Wirawan1,4
1. Post Graduate Program in Public Health Sciene, Udayana University, Bali, Indonesia 2. The Kirby Institute, The University of New South Wales, Australia
3. Kerti Praja Foundation
ABSTRACT
Background. Successful Antiretroviral Therapy (ART) depends on regular and complete patient follow-up. The number loss to follow-up is an important indicator of program effectiveness.This study identified loss to follow-up among HIV positive individuals on ARV treatment in Bali.
Method. Longitudinal analysis of medical records of HIV patients who had started ARV treatment and attending a voluntary counselling and testing clinic between 2002 and December 2012 at Kerti Praja Foundation (YKP). Cox Proportional Hazard were used to assess loss to follow up. Variables included in the analyses were; sex, occupation, mode of HIV transmission, education level, history of opportunistic infection, if ARV was supervised, age, CD4 count at baseline. Supervison of ARV is someone in charge of reminding patient to take antiretroviral. Lost to follow-up was defined as when the patients did not come to seek ART in 3 months at the scheduled visit. Patients were included in analysis if they had more than one visit YKP clinic.
Result. A total of 549 patients were recorded for an ARV visit between 2002 and 2012. One person had only one clinic visit leaving 548 eligible study subjects. Of the 548 patients, 77 (14.1%) were lost to follow up and 471 (85.9%) were retained in treatment, died, or moved away. The median time of loss to follow up is 1.3 years (IQR=0.3-2.5). In multivariate analysis, patients who didn’t have supervisor of ART 1.8 times more likely to loss to follow-up (HR=1.8; 95% CI=1.1-2.83; p=0.018). Patients with history of IDU had less likely to loss to follow-up compare with heterosexual (HR=0.4; 95% CI=0.19-0.71; p=0.003). Patients with lower education and had age above 32 years old less likely to loss to follow-up [(HR=0.6; 95% CI=0.36-0.97; p=0.037) and (HR=0.6; 95% CI=0.33-0.94; p=0.029)].
Conclusion. Supervision is needed to improve retention on ARV treatment. Improving adherence counselling is recommended especially for the patient with higher education, heterosexual, and younger age. The role of Methadone Maintenance Therapy (MMT) in IDU retention was not examined and may have influenced adherence.
