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Incidence and Predictors of Loss to Follow Up among Patients Living with HIV under Dolutegravir in Bunia, Democratic Republic of Congo: A Prospective Cohort Study

Author

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  • Roger T. Buju

    (Department of Public Health, Faculté de Medicine, University of Bunia, Bunia P.O. Box 292, Democratic Republic of the Congo)

  • Pierre Z. Akilimali

    (Department of Biostatistics and Epidemiology, Kinshasa School of Public Health, University of Kinshasa, Kinshasa P.O. Box 11850, Democratic Republic of the Congo)

  • Erick N. Kamangu

    (Département des Sciences de Base, School of Medicine, University of Kinshasa, Kinshasa P.O. Box 11850, Democratic Republic of the Congo)

  • Gauthier K. Mesia

    (Unité de Pharmacologie Clinique, School of Medicine, University of Kinshasa, Kinshasa P.O. Box 11850, Democratic Republic of the Congo)

  • Jean Marie N. Kayembe

    (Department Internal Medicine, School of Medicine, University of Kinshasa, Kinshasa P.O. Box 11850, Democratic Republic of the Congo)

  • Hippolyte N. Situakibanza

    (Department Internal Medicine, School of Medicine, University of Kinshasa, Kinshasa P.O. Box 11850, Democratic Republic of the Congo
    Department of Tropical Medicine, Infectious and Parasitic Diseases, School of Medicine, University of Kinshasa, Kinshasa P.O. Box 11850, Democratic Republic of the Congo)

Abstract

This study aimed to examine the incidence and predictors of loss to follow up (LTFU) in the context of ongoing atrocities caused by armed conflict, where HIV treatment programs and HIV-infected patients may face unique challenges in terms of ART adherence and retention in care. We conducted an observational prospective cohort study of 468 patients living with HIV (PLWHIV) under dolutegravir (DTG) in all health facilities in Bunia between July 2019 and July 2021. Kaplan–Meier plots were used to determine the probability of LTFU as a function of time as inclusive of the cohort. The main outcome variable was LTFU, defined as not taking an ART refill for a period of 3 months or longer from the last attendance for refill, and not yet classified as ‘dead’ or ‘transferred-out.’ The log-rank test was used to compare survival curves based on predictors. Cox proportional hazard modeling was used to measure predictors of LTFU from the baseline until 31 July 2021 (the endpoint). A total of 3435.22 person-months (p-m) were involved in follow up, with an overall incidence rate of 33.48 LTFU per 1000 p-m. Patients who had less experience with ART at enrolment and the ethnically Sudanese, had a higher hazard of being LTFU compared to their reference groups. This study reports a high LTFU rate in this conflict setting. An ART program in such a setting should pay more attention to naive patients and other particularly vulnerable patients such as Sudanese during the pre-ART phase. The study implies the implementation of innovative strategies to address this high risk of being LTFU, reducing either the cost or the distance to the health facility.

Suggested Citation

  • Roger T. Buju & Pierre Z. Akilimali & Erick N. Kamangu & Gauthier K. Mesia & Jean Marie N. Kayembe & Hippolyte N. Situakibanza, 2022. "Incidence and Predictors of Loss to Follow Up among Patients Living with HIV under Dolutegravir in Bunia, Democratic Republic of Congo: A Prospective Cohort Study," IJERPH, MDPI, vol. 19(8), pages 1-9, April.
    • Handle: RePEc:gam:jijerp:v:19:y:2022:i:8:p:4631-:d:791894
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    References listed on IDEAS

    as
    1. Roger T. Buju & Pierre Z. Akilimali & Erick N. Kamangu & Gauthier K. Mesia & Jean Marie N. Kayembe & Hippolyte N. Situakibanza, 2022. "Predictors of Viral Non-Suppression among Patients Living with HIV under Dolutegravir in Bunia, Democratic Republic of Congo: A Prospective Cohort Study," IJERPH, MDPI, vol. 19(3), pages 1-13, January.
    2. Pierre Zalagile Akilimali & Patou Masika Musumari & Espérance Kashala-Abotnes & Patrick Kalambayi Kayembe & François B Lepira & Paulin Beya Mutombo & Thorkild Tylleskar & Mapatano Mala Ali, 2017. "Disclosure of HIV status and its impact on the loss in the follow-up of HIV-infected patients on potent anti-retroviral therapy programs in a (post-) conflict setting: A retrospective cohort study fro," PLOS ONE, Public Library of Science, vol. 12(2), pages 1-13, February.
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    Cited by:

    1. Roger T. Buju & Pierre Z. Akilimali & Nguyen-Toan Tran & Erick N. Kamangu & Gauthier K. Mesia & Jean Marie N. Kayembe & Hippolyte N. Situakibanza, 2022. "Determinants of Survival of HIV Patients Receiving Dolutegravir: A Prospective Cohort Study in Conflict-Affected Bunia, Democratic Republic of Congo," IJERPH, MDPI, vol. 19(16), pages 1-10, August.

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