Treatment default among patients initiating HAART at the Korle-Bu Teaching Hospital in Accra, Ghana

Loss-to-follow-up (LTFU) during highly active antiretroviral therapy (HAART) may lead to treatment failure and increased mortality among HIV-infected patients. We investigated LTFU rate among HIV-infected patients at Korle-Bu Teaching Hospital (KBTH), and sought to identify sub-groups at-risk for treatment default in order to improve outcomes among high-risk patients.

We conducted a cross-sectional retrospective chart review of 290 HIV-infected patients who initiated HAART at KBTH between January 1, 2008, and June 31, 2008. Patients were classified as LTFU if they did not return for regularly scheduled care within the study period. Chi-square and t-tests were used to compare demographic and clinical characteristics of patients continuing treatment and those who defaulted.

Of the 290 patients who initiated HAART, 41 (14%) defaulted, and 7 (2%) died during the 18-month study period. The mean age was 38.7 ± 9.4 years and 184 (64%) were female. The mean baseline CD4 cell count was 183 ± 144 cells/µl. Age, gender, educational level, marital status, presence of opportunistic infection, body mass index, baseline CD4 cell count, WHO disease stage 3 or 4, HAART initiation while pregnant, incidence of poor adherence, and time to initiating HAART after clinic enrollment were not associated with treatment default (P> 0.05).

A majority of patients initiating HAART in an urban Ghanaian clinic remained in care through one-year of follow-up. Patients who defaulted therapy were indistinguishable demographically and clinically from those who remained in care. Standardized pre-treatment adherence counseling sessions may have influenced the favorable outcomes.