Facility-level factors influencing retention of patients in HIV care in East Africa

Beth Rachlis, Giorgos Bakoyannis, Philippa Easterbrook, Becky Genberg, Ronald Scott Braithwaite, Craig R. Cohen, Elizabeth A. Bukusi, Andrew Kambugu, Mwebesa Bosco Bwana, Geoffrey R. Somi, Elvin H. Geng, Beverly Musick, Constantin T. Yiannoutsos, Kara Wools-Kaloustian, Paula Braitstein

Research output: Contribution to journalArticlepeer-review

26 Scopus citations


Losses to follow-up (LTFU) remain an important programmatic challenge. While numerous patient-level factors have been associated with LTFU, less is known about facility-level factors. Data from the East African International epidemiologic Databases to Evaluate AIDS (EA-IeDEA) Consortium was used to identify facility-level factors associated with LTFU in Kenya, Tanzania and Uganda. Patients were defined as LTFU if they had no visit within 12 months of the study endpoint for pre-ART patients or 6 months for patients on ART. Adjusting for patient factors, shared frailty proportional hazard models were used to identify the facility-level factors associated with LTFU for the pre- and post-ART periods. Data from 77,362 patients and 29 facilities were analyzed. Median age at enrolment was 36.0 years (Interquartile Range: 30.1, 43.1), 63.9% were women and 58.3% initiated ART. Rates (95% Confidence Interval) of LTFU were 25.1 (24.7-25.6) and 16.7 (16.3-17.2) per 100 personyears in the pre-ART and post-ART periods, respectively. Facility-level factors associated with increased LTFU included secondary-level care, HIV RNA PCR turnaround time >14 days, and no onsite availability of CD4 testing. Increased LTFU was also observed when no nutritional supplements were provided (pre-ART only), when TB patients were treated within the HIV program (pre-ART only), and when the facility was open≤ 4 mornings per week (ART only). Our findings suggest that facility-based strategies such as point of care laboratory testing and separate clinic spaces for TB patients may improve retention.

Original languageEnglish (US)
Article numbere0159994
JournalPloS one
Issue number8
StatePublished - Aug 2016
Externally publishedYes

ASJC Scopus subject areas

  • General


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