ArticleBMJ open2020
Competing risk of mortality on loss to follow-up outcome among patients with HIV on ART: a retrospective cohort study from the Zimbabwe national ART programme.
Article in BMJ open, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 16 papers, 2 of them syntheses that pooled it.
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Who cites it
16 citing papers in PubMed, 2 syntheses or guidelines pooled it, 28 citations in OpenAlex.
- Incidence and predictors of loss to follow-up among adults on antiretroviral therapy in Ethiopia: a systematic review and meta-analysis of cohort studies.AIDS research and therapy · 2026Pooled it
- Characterizing the HIV care continuum among children and adolescents with HIV in eastern and southern Africa in the era of "Universal Test and Treat": A systematic review and meta-analysis.Journal of the International AIDS Society · 2025Pooled it
- Mortality and Loss to Follow-Up Among Adolescents and Young Adults Attending HIV Care Programs in Kenya.AIDS patient care and STDs · 2023Trial
- The loss to follow-up of participants excluded from the NAMSAL trial: a retrospective cohort study.Scientific reports · 2025Article
- A competing risk analysis of predictors of time to lost to follow-up among adults with TB/HIV coinfection in Bahir Dar.Scientific reports · 2025Article
- Geographic variations and determinants of ever-tested for HIV among women aged 15-49 in Sierra Leone: a spatial and multi-level analysis.BMC public health · 2025Article
- Characteristics and six-month viral load suppression of clients presenting with advanced HIV disease in South Africa.PLOS global public health · 2025Article
- Time-dependent predictors of loss to follow-up in HIV care in low-resource settings: A competing risks approach.PloS one · 2025Article
- Evaluating the feasibility and attitudes towards SARS-CoV-2 self-testing in a rural population in Zimbabwe: a cross-sectional survey.BMJ open · 2024Article
- Investigating the Determinants of Mortality before CD4 Count Recovery in a Cohort of Patients Initiated on Antiretroviral Therapy in South Africa Using a Fine and Gray Competing Risks Model.Tropical medicine and infectious disease · 2024Article
- Article
- Incidence and predictors of attrition among adults receiving first line anti-retroviral therapy at public health facility in Adea Berga district, Oromia, Ethiopia.Journal of public health research · 2023Article
- Article
- Loss to Follow-Up Risk among HIV Patients on ART in Zimbabwe, 2009-2016: Hierarchical Bayesian Spatio-Temporal Modeling.International journal of environmental research and public health · 2022Article
- Clinical outcomes among adolescents living with HIV in Kenya following initiation on antiretroviral treatment.PLOS global public health · 2022Article
- Factors associated with treatment outcomes of patients with drug-resistant tuberculosis in China: A retrospective study using competing risk model.Frontiers in public health · 2022Article
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Authors and funding
4 authors at 2 institutions in 3 countries.
Funding
Abstract
objectiveTo determine the loss to follow-up (LTFU) rates at different healthcare levels after antiretroviral therapy (ART) services decentralisation among ART patients who initiated ART between 2004 and 2017 using the competing risk model in addition to the Kaplan-Meier and Cox regressions analysis.
designA retrospective cohort study.
settingThe study was done in Zimbabwe using a nationwide routinely collected HIV patient-level data from various health levels of care facilities compiled through the electronic patient management system (ePMS).
participantsWe analysed 390 771 participants aged 15 years and above from 538 health facilities. OUTCOMES: The primary endpoint was LTFU defined as a failure of a patient to report for drug refill for at least 90 days from last appointment date or if the patient missed the next scheduled visit date and never showed up again. Mortality was considered a secondary outcome if a patient was reported to have died.
resultsThe total exposure time contributed was 1 544 468 person-years. LTFU rate was 5.75 (95% CI 5.71 to 5.78) per 100 person-years. Adjustment for the competing event independently increased LTFU rate ratio in provincial and referral (adjusted sub-HRs (AsHR) 1.22; 95% CI 1.18 to 1.26) and district and mission (AsHR 1.47; 95% CI 1.45 to 1.50) hospitals (reference: primary healthcare); in urban sites (AsHR 1.61; 95% CI 1.59 to 1.63) (reference: rural); and among adolescence and young adults (15-24 years) group (AsHR 1.19; 95% CI 1.16 to 1.21) (reference: 35-44 years). We also detected overwhelming association between LTFU and tuberculosis-infected patients (AsHR 1.53; 95% CI 1.45 to 1.62) (reference: no tuberculosis).
conclusionsWe have observed considerable findings that 'leakages' (LTFU) within the ART treatment cascade persist even after the decentralisation of health services. Risk factors for LTFU reflect those found in sub-Saharan African studies. Interventions that retain patients in care by minimising any 'leakages' along the treatment cascade are essential in attaining the 90-90-90 UNAIDS fast-track targets.
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