Retention in Care, Loss to Follow-up and Associated Patient Characteristics: A Retrospective Cohort Study among Adults Receiving Antiretroviral Therapy from Urban Health Facilities in Ghana

Abstract

Introduction: Assessing treatment outcomes among persons receiving antiretroviral therapy (ART) for human immunodeficiency virus (HIV) infection is important for clinical and public health decisions. Although Komfo Anokye Teaching Hospital and Suntreso Government Hospital have offered ART to several patients for more than a decade, their treatment outcomes have not been well reported. We aimed at investigating retention in care, loss to follow-up, and patient characteristics associated with these outcomes among HIV-infected adults receiving ART from two urban treatment sites in the Ashanti Region of Ghana in order to design interventions to improve therapy outcomes. Materials and method: We conducted medical records review (MRR) from September to December 2020 among HIVinfected patients receiving ART from two urban ART sites in Kumasi, Ghana. Patients were eligible if they were adults aged ≥ 20-years and had taken ART for ≥ 3-years as of December 2019. Retention in care, loss to follow-up (LTFU) and mortality among our study patients were investigated from ART initiation up to 3-years. In this study, retention of patients in care was defined as actively attending clinic and picking ARVs within the follow-up period. Loss to follow-up was defined as having discontinued clinic attendance and ARVs pick-up for more than 90 days after the last scheduled visit. Logistic regression analyses were performed to study the treatment outcomes and their associated patient characteristics. Results: Of the 370 patients whose medical records were reviewed, 258 (69.7%) were female, 260 (70.3%) were retained in ART up to 3-years, 29.7% were lost to follow-up of whom 9.1% were confirmed dead. Overall mortality was therefore 2.7%. Being employed (AOR 2.55, p = 0.015, 95% CI 1.201-5.4.414), female (AOR 1.319, CI 95% 0.754-2.310), divorced (AOR 1.266, CI 95% 0.506-3.166) and having primary level of education (AOR 1.539, CI 95% 0.915-2.590) were associated with greater odds of being retained in care. Conclusion: Although mortality among our study cohort was low and bout 70% were retained in ART up to 3-years, loss to follow-up was high, especially within the first 6 months. Effective follow-up interventions are required to reduce LTFU during the first 6 months of treatment and among younger adults, patients with secondary and tertiary education as well as single and married patients who were less likely to be retained in care.