People lost to follow-up (LTFU) from HIV care have an increased risk of worse health. The objective of this study is to create and validate a risk score to predict LTFU among PLWH in Catalonia and the Balearic Islands.
Methods
6661 PLWH were included. LTFU were those without contact with HIV care for 12 months or more. Logistic regression models were used to assess the role of independent factors on LTFU. The validation included a 10-fold iteration to predict the performance of the regression model and the Area under the ROC Curve (AUC). Regression coefficients were rounded and summed to construct the score.
Results
Determinants of LTFU included being younger than 34 years (OR: 1.80, CI, 1.44–2.23), not having been born in Spain (OR: 1.32, 1.11–1.58), men who inject drugs (OR: 2.10, 1.38–3.19), having a detectable viral load (OR: 3.14, 2.47–3.99), and ≤2.5 years since HIV diagnosis (OR: 3.84, 3.10–4.75). The validation of determinants resulted in a mean AUC of 0.69 and the risk-score revealed that 28.8% had a medium and 3.4% a high risk of LTFU respectively.
JaenACasabonaJEsteveA, et al.Clinical-epidemiological characteristics and antiretroviral treatment trends in a cohort of HIV infected patients. The PISCIS Project. Med Clin2005; 124: 525–531.
4.
BenitoCAReyes-UrueñaJFusterAS, et al.Monitoring and evaluation of HIV in Catalonia, getting closer to the 90-90-90 objectives. Rev Esp Salud Publica. 2019; 93: e1-16.
5.
MugaveroMJLinH-YWilligJH, et al.Missed visits and mortality among patients establishing initial outpatient HIV treatment. Clin Infect Dis Off Publ Infect Dis Soc Am2009; 48: 248–256.
6.
EdwardsJKColeSRWestreichD, et al.Loss to clinic and five-year mortality among HIV-infected antiretroviral therapy initiators. PLoS One. 2014; 9(7): e102305. doi:10.1371/journal.pone.0102305.
7.
GiordanoTPGiffordALWhiteAC, et al.Retention in care: a challenge to survival with HIV infection. Clin Infect Dis2007; 44: 1493–1499.
8.
CrawfordTNSandersonWTThorntonA. Impact of poor retention in HIV medical care on time to viral load suppression. J Int Assoc Phys AIDS Care2014; 13: 242–249.
9.
LebouchéBYazdanpanahYGérardY, et al.Incidence rate and risk factors for loss to follow-up in a French clinical cohort of HIV-infected patients from January 1985 to January 1998. HIV Med2006; 7: 140–145.
10.
CuzinLDellamonicaPYazdanpanahY, et al.Characteristics and consequences of medical care interruptions in HIV-infected patients in France. Epidemiol Infect2016; 144: 2363–2370.
11.
MocroftAKirkOAldinsP, et al.Loss to follow-up in an international, multicentre observational study. HIV Med2008; 9: 261–269.
12.
DangBNWestbrookRAHartmanCM, et al.Retaining HIV patients in care: The role of initial patient care experiences. AIDS Behav2016; 20: 2477–2487.
13.
TeiraREspinosaNGutiérrezMM, et al.Losses to follow-up of HIV-infected people in the Spanish VACH cohort over the period between 2013 and 2014: The importance of sociodemographic factors. Enferm Infecc Microbiol Clín2019; 37: 361–366.
14.
BrugueraANomahDMoreno-FornésS, et al.Cohort profile: PISCIS, a population-based cohort of people living with HIV in Catalonia and Balearic Islands. Int J Epidemiol2023; 52: e241–e252.
15.
CampbellCNJAmbrosioniJMiroJM, et al.The continuum of HIV care in Catalonia. AIDS Care - Psychol Socio-Med Asp AIDSHIV2015; 27: 1449–1454.
Generalitat de Catalunya. Agència de Qualitat i Avaluació Sanitàries de Catalunya. Barcelona, Spain: Programa Públic d’Analítica de Dades per a la Recerca i la Innovació en Salut a Catalunya – PADRIS, https://aquas.gencat.cat/ca/detall/article/padris (2017).
19.
Luque-FernandezMARedondo-SánchezDMaringeC. cvauroc: Command to compute cross-validated area under the curve for ROC analysis after predictive modeling for binary outcomes. STATA J2019; 19: 615–625.
20.
SteyerbergEWHarrellFEBorsboomGJ, et al.Internal validation of predictive models: Efficiency of some procedures for logistic regression analysis. J Clin Epidemiol2001; 54: 774–781.
21.
MandrekarJN. Receiver operating characteristic curve in diagnostic test assessment. J Thorac Oncol Off Publ Int Assoc Study Lung Cancer2010; 5: 1315–1316.
22.
Sobrino-VegasPGutiérrezFBerenguerJ, et al.The Cohort of the Spanish HIV Research Network (CoRIS) and its associated biobank; organizational issues, main findings and losses to follow-up. Enferm Infecc Microbiol Clín2011; 29: 645–653.
23.
GiordanoTPHartmanCGiffordAL, et al.Predictors of retention in HIV care among a national cohort of US veterans. HIV Clin Trials2009; 10: 299–305.
24.
LourençoLColleyGNosykB, et al.High levels of heterogeneity in the HIV cascade of care across different population subgroups in British Columbia, Canada. PLoS One2014; 9: e115277.
25.
Martinez-GuerraBAValdez-VenturaRCaro-VegaY, et al.Gaps in the continuum of care in HIV-positive adults and the need for caution in those returning to care after loss to follow-up. AIDS Care. 2023; 35(10): 1604–1611.
26.
FournierALParientiJ-JChampenoisK, et al.Incidence and risk factors for medical care interruption in people living with HIV in a French provincial city. PLoS One2020; 15: e0240417.
27.
RudyBJMurphyDAHarrisDR, et al.Patient-related risks for nonadherence to antiretroviral therapy among HIV-infected youth in the United States: A study of prevalence and interactions. AIDS Patient Care STDS2009; 23: 185–194.
28.
HaasADLienhardRDiddenC, et al.Mental health, ART adherence, and viral suppression among adolescents and adults living with HIV in South Africa: A cohort study. AIDS Behav. 2023; 27(6): 1849–1861. doi:10.1007/s10461-022-03916-x.
29.
MugoCKohlerPKumarM, et al.Effect of HIV stigma on depressive symptoms, treatment adherence, and viral suppression among youth with HIV. AIDS. 2022; 37(5): 813–821. doi:10.1097/QAD.0000000000003473.
30.
ComelliAIzzoIDonatoF, et al.Disengagement and reengagement of HIV continuum of care in a single center cohort in northern Italy. HIV Res Clin Pract2019; 20: 1–11.
31.
DeblondeJSasseADel AmoJ, et al.Restricted access to antiretroviral treatment for undocumented migrants: a bottle neck to control the HIV epidemic in the EU/EEA. BMC Publ Health2015; 15: 1228.
32.
BaggaleyRFNazarethJDivallP, et al.National policies for delivering tuberculosis, HIV and hepatitis B and C virus infection services for refugees and migrants among Member States of the WHO European Region. J Trav Med2023; 30: taac136.
33.
GogishviliMFlórezKRCostaSA, et al.A qualitative study on mixed experiences of discrimination and healthcare access among HIV-positive immigrants in Spain. BMC Publ Health2021; 21: 385.
34.
NdumbiPDel RomeroJPulidoF, et al.Barriers to health care services for migrants living with HIV in Spain. Eur J Publ Health2018; 28: 451–457.
35.
NdiayeBOuld-KaciKSalleronJ, et al.Incidence rate and risk factors for loss to follow-up in HIV-infected patients from five French clinical centres in Northern France - January 1997 to December 2006. Antivir Ther2009; 14: 567–575.
36.
SeongHChoiYKimMJ, et al.Rate of and risk factors for loss to follow up in HIV-infected patients in Korea: The Korea HIV/AIDS cohort study. Infect Chemother. 2023; 55(1): 69–79. doi:10.3947/ic.2022.0059.
37.
MushySEMtisiEMboggoE, et al.Predictors of the observed high prevalence of loss to follow-up in ART-experienced adult PLHIV: A retrospective longitudinal cohort study in the Tanga Region, Tanzania. BMC Infect Dis2023; 23: 92.
38.
GariSDoig-AcuñaCSmailT, et al.Access to HIV/AIDS care: A systematic review of socio-cultural determinants in low and high income countries. BMC Health Serv Res2013; 13: 198.
39.
FrijtersEMHermansLEWensingAMJ, et al.Risk factors for loss to follow-up from antiretroviral therapy programmes in low-income and middle-income countries. AIDS Lond Engl2020; 34: 1261–1288.
40.
MberiMNKuonzaLRDubeNM, et al.Determinants of loss to follow-up in patients on antiretroviral treatment, South Africa, 2004–012: A cohort study. BMC Health Serv Res2015; 15: 259.
41.
OrrellCKaplanRWoodR, et al.Virological breakthrough: A risk factor for loss to follow-up in a large community-based cohort on antiretroviral therapy. AIDS Res Treat2011; 2011: 469127.
42.
AgolorySGAuldAFOdafeS, et al.High rates of loss to follow-up during the first year of pre-antiretroviral therapy for HIV patients at sites providing pre-ART care in Nigeria, 2004–2012. PLoS One2017; 12: e0183823.
43.
JamiesonLRosenSPhiriB, et al.How soon should patients be eligible for differentiated service delivery models for antiretroviral treatment? Evidence from a retrospective cohort study in Zambia. BMJ Open2022; 12: e064070.
44.
AriciCRipamontiDMaggioloF, et al.Factors associated with the failure of HIV-positive persons to return for scheduled medical visits. HIV Clin Trials2002; 3: 52–57.
45.
EngelhardEANSmitCVan SighemA, et al.Impact of HIV care facility characteristics on the cascade of care in HIV-infected patients in The Netherlands. AIDS Lond Engl2016; 30: 301–310.
46.
IzquierdoRRavaMMoreno-GarcíaE, et al.HIV medical care interruption among people living with HIV in Spain, 2004–2020. AIDS Lond Engl2023; 37: 1277–1284.
47.
PenceBWBengtsonAMBoswellS, et al.Who will show? Predicting missed visits among patients in routine HIV primary care in the United States. AIDS Behav2019; 23: 418–426.
48.
Palacio-VieiraJMoreno-FornésSDíazY, et al.Who is lost to follow-up in HIV care? Assessment of care retention over time and the impact of COVID-19. Longitudinal analysis of the PISCIS cohort. HIV Med. 2023; 24(9): 965–978. doi:10.1111/hiv.13486.
