Lost to follow-up: a challenge over 10 years

Area of Science:

• Infectious Diseases
• Public Health
• Clinical Medicine

Background:

• Loss to follow-up (LFU) is a critical issue impacting the management and outcomes of patients with Human Immunodeficiency Virus (HIV).
• Effective HIV care requires consistent patient engagement and adherence to treatment regimens.
• Understanding the factors contributing to LFU is essential for developing targeted interventions to improve patient retention.

Purpose of the Study:

• To evaluate the rate of LFU over a 10-year period in a single Italian center.
• To characterize the socio-demographic and clinical profiles of patients who were LFU.
• To identify predictors associated with disengagement from HIV care.

Main Methods:

• A retrospective analysis of 563 patients who were LFU between 2008 and 2017.
• Categorization of LFU patients into subgroups: untraceable, deceased, re-engaged elsewhere, and re-engaged at the center.
• Multivariable analysis to identify predictors of death, being untraceable, and re-engagement elsewhere.

Main Results:

• The proportion of LFU patients decreased slightly from 6.5% in 2008 to 4.8% in 2017.
• Predictors of death included older age, AIDS diagnosis, and drug addiction.
• Non-Italian nationality and shorter duration of combination antiretroviral therapy (cART) predicted being untraceable.
• Patients residing farther from the center were more likely to be re-engaged elsewhere.

Conclusions:

• Despite a slight decrease in the LFU rate, the problem remains significant in HIV management.
• Identifying predictors like age, AIDS, drug addiction, nationality, cART history, and distance from the center is crucial.
• Developing and implementing effective strategies to enhance retention in HIV care is urgently needed.