J Acquir Immune Defic Syndr

ObjectiveTo identify risk factors for loss to follow up (LTFU) in an HIV-infected pediatric population in Dar es Salaam, Tanzania between 2004 and 2011.DesignLongitudinal analysis of 6236 HIV-infected children.MethodsWe conducted a prospective cohort study of 6236 pediatric patients enrolled in care and treatment in Dar es Salaam from October 2004 to September 2011. LTFU was defined as missing a clinic visit for >90 days for patients on ART and for >180 days for patients in care and monitoring. The relationship of baseline and time-varying characteristics to risk of LTFU was examined using a Cox proportional hazards model.Results2130 children (34%) were LTFU over a median follow up of 16.7 months (IQR, 3.4\u201336.9). Factors independently associated with a higher risk of LTFU were age 2 years (RR=1.59, 95% CI 1.40\u20131.80), diarrhea at enrollment (RR=1.20, 95% CI 1.03\u20131.41), a low mid-upper arm circumference for age (RR=1.20, CI 1.05\u20131.37), eating protein 3 times a week (RR=1.39, 95% CI 1.05\u20131.90), taking cotrimoxazole (RR=1.39, 95% CI 1.06\u20131.81), initiating onto antiretrovirals (RR=1.37, 95% CI 1.17\u20131.61), receiving treatment at a hospital instead of a local facility (RR=1.39, 95% CI 1.06\u20131.41), and starting treatment in 2006 or later (RR=1.10, 95% CI 1.04\u20131.16).ConclusionsHealth workers should be aware of pediatric patients who are at greatest risk of LTFU, such as younger and undernourished patients, so that they can proactively counsel families about the importance of visit adherence. Findings support decentralization of HIV care to local facilities as opposed to hospitals.20152016-11-01T00:00:00ZK24 HD058795/HD/NICHD NIH HHS/United StatesK24 DK104676/DK/NIDDK NIH HHS/United StatesR01 HD043688-01/HD/NICHD NIH HHS/United StatesU2G PS001966/PS/NCHHSTP CDC HHS/United StatesR01 HD043688/HD/NICHD NIH HHS/United StatesK24HD058795/HD/NICHD NIH HHS/United States5U2GPS001966-04/PHS HHS/United States26247894PMC465089