Antiretroviral Therapy Inadequate Monitoring in Advanced Stages of Disease with Lack of Supportive Counseling Increases Attrition among Patients on Antiretroviral Treatment at a Large Urban Clinic in Uganda

Background: The purpose of this case–control study was to identify risk factors for loss to follow-up (LTFU).Methods: Cases and controls were selected from HIV-positive patients, aged 18 years and older, on antiretroviral therapy (ART) at the Infectious Diseases Clinic (IDC) in January 2008. As cases, we selected 209 patients who in 2008 did not return to the clinic within 90 days of their scheduled appointment date. As controls, we randomly selected 626 patients from the 5872 patients who were following up at the end of December 2008. Results: In multivariable logistic regression analysis, urban or semiurban residence, World Health Organization disease stage III or IV at ART initiation, a median CD4 count at last visit <200 cells/mm3, tuberculosis (TB) in the 6 months before the last visit, absence of counseling before ART initiation, and no disclosure of HIV status were associated with LTFU. Conclusion: This study demonstrates the importance of close patient monitoring in advanced stages of disease, suppor-tive counseling for patients initiating ART, extra psychosocial support for patients with TB and HIV coinfection, assisting patients with disclosure, and setting up a good referral system to retain patients on ART