Public Health in Practice最新文献

{"title":"Task sharing for the management of non-communicable diseases in a humanitarian setting: An innovative approach in a low-middle income country (LMIC)","authors":"Myrna Doumit ,&nbsp;Sahar Masri ,&nbsp;Iza Ciglenecki ,&nbsp;Manuel Albela","doi":"10.1016/j.puhip.2025.100643","DOIUrl":"10.1016/j.puhip.2025.100643","url":null,"abstract":"<div><div>The World Health Organization (WHO) defines task shifting as the balanced reallocation of tasks from highly experienced professionals to those with more limited training, thus allowing the existing human resources to be used more efficiently. In Lebanon, there is no documented evidence yet of task sharing between physicians and nurses in the usual primary healthcare setting, let alone for Non-Communicable Disease (NCD) management.</div></div><div><h3>Objective</h3><div>This study aims to explore the experiences of healthcare providers and patients regarding task sharing.</div></div><div><h3>Study design</h3><div>This study employed a qualitative descriptive design, utilizing a cross-sectional approach.</div></div><div><h3>Method</h3><div>Qualitative data collection started in April–May 2022. Data collection was conducted with three focus groups: nurses (n = 9), patients (n = 11), and physicians (n = 5) from two clinics in two different rural areas, using purposeful sampling. A thematic analysis method, as described by Braun and Clarke, was used to guide the analysis.</div></div><div><h3>Results</h3><div>This study yielded four themes: An innovative approach to care, A prevailing culture of trust and collaboration, a Synergistic Outcome, and A Call for Improvement.</div></div><div><h3>Conclusion</h3><div>This study has identified an innovative approach to care, as demonstrated by the practices performed at the two clinics. Task shifting is a means of ensuring nurses' satisfaction. Therefore, it may positively impact retention at a time when we are witnessing an unprecedented migration of nurses from low- and middle-income countries (LMICs) to high-income countries (HICs). Interprofessional education needs to be reinforced at the undergraduate level to enhance collaboration among health care workers after graduation. At the policy level, considerable work is necessary to ensure that all stakeholders’ voices are represented at the decision-making table and heard.</div></div>","PeriodicalId":34141,"journal":{"name":"Public Health in Practice","volume":"10 ","pages":"Article 100643"},"PeriodicalIF":1.9,"publicationDate":"2025-07-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144722575","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Exploring the effects catastrophic health expenditure due to non-communicable diseases and coping strategies: A case study among households in Bangladesh","authors":"N.M. Rabiul Awal Chowdhury ,&nbsp;Salma Akter Urme ,&nbsp;Asaduzzaman Hridoy ,&nbsp;Fahima Nusrat ,&nbsp;Md Shahgahan Miah","doi":"10.1016/j.puhip.2025.100642","DOIUrl":"10.1016/j.puhip.2025.100642","url":null,"abstract":"<div><h3>Objectives</h3><div>Non-communicable diseases (NCDs), due to their chronic nature, lead to long-term and significant health burdens that result in catastrophic expenses for individuals and communities. This study explores the socioeconomic effects of catastrophic health costs on households with family members experiencing NCDs and their coping mechanisms in rural areas of Bangladesh.</div></div><div><h3>Study design</h3><div>Qualitative study.</div></div><div><h3>Methods</h3><div>Case studies were conducted with ten NCD patients who had experienced catastrophic events and their close contacts. Purposive sampling strategies were used to recruit participants from two sub-districts in areas with a high prevalence of NCDs. In-depth interviews and observations were conducted, and documents (e.g. hospital and diagnosis bills, medicine purchase receipts) were reviewed. Data were analysed using thematic analysis.</div></div><div><h3>Results</h3><div>Data revealed that the treatment costs of NCDs are multifaceted and long-term. This catastrophic health expenditure has many economic effects, such as compromising food, housing, living standards and quality of life. It also has non-economic effects, including social stigmatisation, adjusting wishes and dreams, hampering children's education, disrupting family relationships and undermining social dignity. Households' adaptive strategies include loaning and borrowing, selling assets, using savings, seeking assistance from friends and relatives, reconciling living standards and even adopting alternative medicines.</div></div><div><h3>Conclusions</h3><div>Thisstudy highlights the socioeconomic impact of catastrophic health costs associated with NCDs and how households adapt and cope with these expenses. The results increase understanding of the impact of NCDs and the importance of managing the economic burden. Results highlight the necessity for a strategic plan to aid families affected by chronic NCDs.</div></div>","PeriodicalId":34141,"journal":{"name":"Public Health in Practice","volume":"10 ","pages":"Article 100642"},"PeriodicalIF":2.2,"publicationDate":"2025-07-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144623455","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Upholding the right to health of forcibly displaced children in Europe","authors":"Amy Stevens ,&nbsp;Zeliha Öcek ,&nbsp;Sergey Sargsyan ,&nbsp;Michelle Black","doi":"10.1016/j.puhip.2025.100641","DOIUrl":"10.1016/j.puhip.2025.100641","url":null,"abstract":"<div><div>In 2023 Europe hosted an estimated 9 million children who had been forcibly displaced from their homes because of conflict, persecution, violence, natural or environmental disasters, climate crisis, human trafficking and extreme poverty. Their experiences pre, during and post migration impact their health, wellbeing and development. Countries across the European Region have a moral and legal duty to uphold the right to health of all children living within their borders, irrespective of immigration status. However, many countries are falling short of delivering on these obligations. The rise in populist radical right politics and anti-immigrant sentiment across the Region has led to an increase in potentially health-harming immigration policies and practices. Challenges to meeting the health needs of displaced children include underfunded health systems, limited specialist services, health and care workforce shortages, and lack of data to inform evidence-based policy and practice. Displaced children are often subjected to restrictions on service entitlements; systemic racism, xenophobia and discrimination in health systems; and language, cultural, social, financial, and administrative barriers to care. Cross-country collaboration is required to address the drivers of forced migration; increase availability of safe and legal routes for refugees; and ensure health systems across the Region have the data, resource and capacity required to respond to the needs of displaced children. Essential policies supporting a child's right to health include: provision of child and family-centred community alternatives to refugee camps and immigration detention; provision of healthcare and education entitlements equitable to children of the host nation; protection of children from violence and exploitation; and delivery of quality and inclusive trauma-informed healthcare that accounts for language needs, cultural diversity and safeguarding risks. With political commitment and coordinated efforts, ensuring the right to health for displaced children is achievable and should be prioritised.</div></div>","PeriodicalId":34141,"journal":{"name":"Public Health in Practice","volume":"10 ","pages":"Article 100641"},"PeriodicalIF":2.2,"publicationDate":"2025-07-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144595533","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Letter to editor regarding: “Local authorities need tailored research ethics processes to support research capacity building”","authors":"Geoff Middleton ,&nbsp;Sarah Varga ,&nbsp;Susan Hampshaw ,&nbsp;Geraldine Byrne ,&nbsp;Alex-Jade Delahunty ,&nbsp;Richard Gettings ,&nbsp;Lorna Dowrick ,&nbsp;Catherine Homer","doi":"10.1016/j.puhip.2025.100640","DOIUrl":"10.1016/j.puhip.2025.100640","url":null,"abstract":"","PeriodicalId":34141,"journal":{"name":"Public Health in Practice","volume":"10 ","pages":"Article 100640"},"PeriodicalIF":2.2,"publicationDate":"2025-07-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144596579","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Morbidity patterns of persons in prisons compared to the general Hungarian population between 2017 and 2019","authors":"P. Fadgyas-Freyler ,&nbsp;Á. Münnich ,&nbsp;J. Molnár ,&nbsp;K. Kósa","doi":"10.1016/j.puhip.2025.100639","DOIUrl":"10.1016/j.puhip.2025.100639","url":null,"abstract":"<div><h3>Objectives</h3><div>Prison population around the globe tends be among the most marginalized population groups. Many of these persons struggle with numerous health problems, primarily with infectious diseases and mental disorders. Our goal was to analyse morbidity of prisoners compared to age- and gender-matched controls.</div></div><div><h3>Study design</h3><div>Case-control study based on administrative data of healthcare utilisation in Hungary between 2017 and 2019.</div></div><div><h3>Methods</h3><div>Patient numbers by ICD-10 chapters and tabulation lists of diagnosis (morbidity groups) were obtained from the government-funded single payer health insurance institute. Convicts were compared to controls matched by age and gender in a 5:1 ratio.</div></div><div><h3>Results</h3><div>The leading causes of healthcare utilisation of prisoners compared to controls by ICD-10 chapters were mental and behavioural disorders and external causes of morbidity, but the relative risk of healthcare use due to infectious diseases was not elevated. When investigating data at a more detailed level, that is, by morbidity groups, the relative risk of healthcare utilisation due to 19 out of a total of 299 morbidity groups was significantly, more than 3 times higher among prisoners compared to controls, and the first five highest relative risks were all due to external causes of injury.</div></div><div><h3>Conclusion</h3><div>The leading causes of morbidity among persons in prisons based on health care utilisation seems to be somewhat different from morbidity patterns identified by other methods such as clinical interviews, screening or estimations. Causes of health care utilisation both at ICD chapter and morbidity group-level is one of several relevant indicators of the health care needs of prison populations that uncovers the groups of most severe maladies among them. However, other sources of data should also be taken into account for the development of effective preventive and rehabilitative interventions. Follow-up of prisoner patients treated in health care would also be recommended to aid rehabilitation.</div></div>","PeriodicalId":34141,"journal":{"name":"Public Health in Practice","volume":"10 ","pages":"Article 100639"},"PeriodicalIF":2.2,"publicationDate":"2025-07-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144571066","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"In-hospital course of children with COVID-19 infection - Results of the German nationwide inpatient sample","authors":"Karsten Keller ,&nbsp;Ingo Sagoschen ,&nbsp;Volker H. Schmitt ,&nbsp;Stefano Barco ,&nbsp;Visvakanth Sivanathan ,&nbsp;Omar Hahad ,&nbsp;Frank P. Schmidt ,&nbsp;Christine Espinola-Klein ,&nbsp;Stavros Konstantinides ,&nbsp;Thomas Münzel ,&nbsp;Lukas Hobohm","doi":"10.1016/j.puhip.2025.100638","DOIUrl":"10.1016/j.puhip.2025.100638","url":null,"abstract":"<div><h3>Objectives</h3><div>To date, few large studies of clinical outcomes in pediatric COVID-19 patients have been reported.</div></div><div><h3>Study design</h3><div>Epidemiological study of the German nationwide inpatient study (GNIS).</div></div><div><h3>Methods</h3><div>We used the GNIS to analyze all hospitalized children ≤18 years with confirmed COVID-19 diagnosis in Germany between Jan 1st and December 31st, 2020.</div></div><div><h3>Results</h3><div>Overall, 3360 children aged ≤18 years were hospitalized with COVID-19 infection in Germany in 2020 (49.8 % females). Among these, 1640 (48.8 %) were aged ≤6 years, 504 (15.0 %) 7 - ≤12 years and 1216 (36.2 %) were aged 13 - ≤18 years. Among these 3360 patients, 3.3 % were treated with mechanical ventilation and 0.23 % died in the hospital. The frequency of venous thromboembolism (0.18 %), vasculopathy (0.68 %), multisystem inflammatory syndrome caused by COVID-19 (0.65 %), and diagnosis of myocarditis (0.60 %) were low. Besides pneumonia and acute respiratory distress syndrome, obesity (OR 6.1 [95 %CI 2.1–18.2], P = 0.001), heart failure (OR 17.0 [95 %CI 6.8–42.1], P &lt; 0.001) and acute/chronic kidney failure (OR 9.5 [95 %CI 4.0–22.2], P &lt; 0.001) were independently associated with mechanical ventilation. Acute or chronic kidney failure (OR 41.4 [95 %CI 7.8–218.6], P &lt; 0.001), liver disease (OR 18.8 [95 %CI 2.5–143.3], P = 0.005), and necessity of mechanical ventilation (OR 7.6 [95 %CI 1.2–47.4], P = 0.031) were independent risk factors for case-fatality.</div></div><div><h3>Conclusions</h3><div>In Germany in 2020, hospitalized children aged ≤18 years with COVID-19 infection had a low case-fatality. Heart, liver and renal failure were associated with adverse COVID-19 complications, such as the need for mechanical ventilation or death. Myocarditis, vasculopathy and venous thromboembolism were rare complications in this patient group.</div></div>","PeriodicalId":34141,"journal":{"name":"Public Health in Practice","volume":"10 ","pages":"Article 100638"},"PeriodicalIF":2.2,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144633276","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Missed opportunities: The unknown impact of the COVID-19 pandemic on early childhood development in the WHO European region","authors":"J.M. White ,&nbsp;C.L. Goodfellow ,&nbsp;A.O. Adeleke ,&nbsp;F.P. Awde ,&nbsp;Y.W. Chua ,&nbsp;A. Jovic ,&nbsp;E. Scott","doi":"10.1016/j.puhip.2025.100636","DOIUrl":"10.1016/j.puhip.2025.100636","url":null,"abstract":"<div><h3>Background</h3><div>Early childhood experiences can promote or adversely affect children's development and wellbeing with lifelong impact. The COVID-19 pandemic disrupted children's and families' lives worldwide. It is important to understand the effect on early childhood development. We aimed to examine what is known about the impact of the COVID-19 pandemic, and the related public health measures, on young children's development.</div></div><div><h3>Study design</h3><div>We carried out a mixed-method study which included a scoping review of review-level evidence about early childhood development over the course of the pandemic compared to beforehand and a web-based survey of early childhood development data published in the WHO European Region.</div></div><div><h3>Methods</h3><div>A systematic search of three databases was used to identify studies, published in English, up to November 2024. Findings were synthesised narratively by developmental domain. A web-based search was used to identify, routinely collected, national surveillance child development data in the WHO European Region. To illustrate the potential role of routine surveillance in the timely identification of developmental concerns, trend data from Scotland was examined.</div></div><div><h3>Results</h3><div>Seven reviews met the inclusion criteria. Most studies examined young children's mental health, while others assessed language development, mother-child bonding, and broader developmental outcomes. Findings were inconsistent, with some studies reporting adverse effects, with others finding no significant changes. There were significant gaps in the availability of national surveillance child development data in WHO European Region countries. Scottish surveillance data identified increases in developmental concerns, which affected disadvantaged groups more.</div></div><div><h3>Conclusions</h3><div>The available evidence about the effect of the COVID-19 pandemic, and related public health measures, on early childhood development is limited and inconclusive. Strengthening data collection and reporting across the WHO European Region is essential for timely and accurate assessment of developmental outcomes and to guide policy development.</div></div>","PeriodicalId":34141,"journal":{"name":"Public Health in Practice","volume":"10 ","pages":"Article 100636"},"PeriodicalIF":2.2,"publicationDate":"2025-06-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144580597","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Inequalities in childhood overweight and obesity: A call to strengthen upstream policy measures","authors":"C.N. Kelly ,&nbsp;P. Da Rosa ,&nbsp;J. Remmele ,&nbsp;N. Tilenbaeva ,&nbsp;R. Arnold ,&nbsp;R. Oberhoffer-Fritz ,&nbsp;H. Fonseca ,&nbsp;M. Buoncristiano ,&nbsp;K. Wickramasinghe ,&nbsp;J. Williams","doi":"10.1016/j.puhip.2025.100637","DOIUrl":"10.1016/j.puhip.2025.100637","url":null,"abstract":"<div><div>The prevalence of overweight and obesity among children and adolescents across Europe is an ongoing public health crisis with both short and long-term consequences affecting health, wellbeing and society. Yet, efforts to address this crisis have mainly focused on individual behaviour change rather than addressing the social, structural and commercial determinants of obesity, leading to limited success and growing inequalities.</div><div>In this commentary we advocate for system-level action. By presenting the most recent data on childhood and adolescent obesity prevalence in the WHO European region, we highlight persistent inequalities, both within and between countries, with a focus on gender, geography and socioeconomic factors. Comprehensive, evidence-based upstream policies can address these disparities, and we advocate for structural, fiscal and regulatory action; investment in accessible parks and recreational facilities; support for a health promotion schools approach and meaningful engagement with children and adolescent to develop programmes, policies and environments that support their health.</div><div>Despite the recognition of this public health crisis and the evidence supporting effective policies, the implementation of obesity policies across Europe is limited. Key challenges include reliance on voluntary measures, resistance from commercial enterprises and the prioritization of economic growth over public health. Currently, a WHO/UNICEF Child and Adolescent Health and Wellbeing Regional Strategy for Europe and Central Asia is under development, with obesity as a priority area providing a pivotal opportunity to harness interest and momentum to effect change as outlined in this article. Obesity policy implementation must also be accompanied by ongoing monitoring of inequalities in obesity in Europe.</div></div>","PeriodicalId":34141,"journal":{"name":"Public Health in Practice","volume":"10 ","pages":"Article 100637"},"PeriodicalIF":2.2,"publicationDate":"2025-06-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144595527","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The health for hearts united dissemination Trial: Implementation costs to reduce cardiovascular risk in African Americans","authors":"Jon C. Mills ,&nbsp;Jeffrey Harman ,&nbsp;Pauline Muturi ,&nbsp;Christina Davis ,&nbsp;Iris Young-Clark ,&nbsp;Penny Ralston","doi":"10.1016/j.puhip.2025.100633","DOIUrl":"10.1016/j.puhip.2025.100633","url":null,"abstract":"<div><h3>Objectives</h3><div>We report on the implementation costs of disseminating Health for Hearts United (HH), a church-based intervention designed to reduce CVD in African Americans.</div></div><div><h3>Study design</h3><div>Cost analysis from dissemination trial of the CVD risk reducing, HH Intervention.</div></div><div><h3>Methods</h3><div>Total costs included materials purchased and labor hours contributed by the academic team to implement the intervention. Materials costs included supplies and printing calculated in total, as well as on a per-participant basis. Labor hours were tracked for each team member. Labor hours were further categorized by the phase of the intervention (Training, Planning &amp; Coaching, Delivery &amp; Recognition). Per-participant and per-church costs are reported as the cost measurement divided by the total health leaders that participated (reached).</div></div><div><h3>Results</h3><div>A total of n = 168 out of 173 health leader participants were reached (97 %). Total program costs were $87,207.66. Total material costs were $13,308.00, while labor costs accounted for 85 % of the total program costs ($87,207.66) at $73,899.66. The Training Phase comprised the largest portion (74 %) of the total labor costs ($54,598.29). Total per-health leader participant reached cost were $519.09.</div></div><div><h3>Conclusions</h3><div>In one of the first studies to report the costs of implementing a CVD risk reducing intervention among African Americans in a church setting, in partnership with a local academic institution, training was the main cost driver. Costs of implementing HH could be reduced by lowering hourly labor cost. Future research should examine costs associated with different methods of implementation (e.g., using more lay people).</div></div>","PeriodicalId":34141,"journal":{"name":"Public Health in Practice","volume":"10 ","pages":"Article 100633"},"PeriodicalIF":2.2,"publicationDate":"2025-06-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144519173","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Determinants of loss to follow-up among people living with HIV receiving antiretroviral therapy in a universal test and treat setting: A retrospective cohort study in Nepal","authors":"Archana Shrestha ,&nbsp;Lisasha Poudel ,&nbsp;Bikram Adhikari ,&nbsp;Saroj Bhandari ,&nbsp;Roman Shrestha ,&nbsp;Rajya Shree Kunwar ,&nbsp;Lok Raj Pandey ,&nbsp;Man Bahadur KC ,&nbsp;Erin C. Wilson ,&nbsp;Keshab Deuba","doi":"10.1016/j.puhip.2025.100634","DOIUrl":"10.1016/j.puhip.2025.100634","url":null,"abstract":"<div><h3>Objectives</h3><div>This study aims to assess the cumulative incidence and rate of loss to follow-up (LTFU) among people living with HIV (PLHIV) in Nepal who begin antiretroviral therapy (ART) early, as well as to identify factors associated with LTFU in the context of the universal test and treat approach.</div></div><div><h3>Study design</h3><div>Retrospective cohort study.</div></div><div><h3>Methods</h3><div>We retrospectively analysed nationally representative routine programme data for all PLHIV initiated on ART from February 19, 2017, to February 18, 2020, and followed up until May 10, 2022. LTFU was defined as a client not returning to the HIV clinic for at least 3 months from the date of their last scheduled appointment. We calculated cumulative incidence rate (IR) and used a multivariable Cox proportional hazards regression model to identify factors associated with LTFU, reporting corresponding 95% confidence intervals (CI).</div></div><div><h3>Results</h3><div>Of the 8192 clients included in our sample, 6797 (82.9 %) started ART within seven days following their HIV diagnosis. The overall IR of LTFU was 4.22 (95 % CI = 3.95–4.51) per 100 person years of observation. The cumulative incidence of LTFU increased over time on ART, from 3.81 % (95 % CI = 3.40–4.26) at 6 months, 6.51 % (95 % CI = 5.97–7.09) at 12 months to 13.41 % (95 % CI = 12.51–14.37) at 48 months. In the multivariable model, factors associated with higher odds of LTFU included initiating treatment within 7 days of diagnosis, younger age, being unmarried, belonging to the Dalit caste, having WHO clinical stage 1 at baseline, and initiation on a non-nucleoside reverse transcriptase inhibitors (NNRTI)-based regimen. Among key populations, sex workers, their clients, men who have sex with men and transgender, people who inject drugs were at higher risk of dropout compared to migrants.</div></div><div><h3>Conclusions</h3><div>In this nationwide cohort, the risk of LTFU increased with time on ART. To optimize the test-and-treat strategy in Nepal, it is crucial to address the unique needs of youth and certain key populations and manage any early adverse drug reactions.</div></div>","PeriodicalId":34141,"journal":{"name":"Public Health in Practice","volume":"10 ","pages":"Article 100634"},"PeriodicalIF":2.2,"publicationDate":"2025-06-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144571854","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}