Incidence and predictors of loss to follow-up among South Sudanese refugees with HIV receiving care in Adjumani District, Uganda

Objectives

HIV care pose a significant challenge in refugee population. We determined the incidence and predictors of loss to follow-up (LTFU) among South Sudanese refugees with HIV in Uganda.

Methods

We conducted a retrospective cohort study in public health facilities in Adjumani District, Uganda, involving South Sudanese refugees with HIV. LTFU was defined as missing 3 or more consecutive months at any point in their care since the start of the study period. A Cox proportional hazards regression analysis was fitted to determine independent predictors of LTFU and results are presented as adjusted hazard ratios (aHRs) with corresponding 95% confidence intervals (CIs).

Results

We included data of 449 participants, with a median age of 37 (interquartile range: 30-43) years. Most were female patients (75.5%, n = 339) receiving care from health center (HC) III (87.3%, n = 392), with baseline World Health Organization stage 1 (79.3%, n = 341), negative baseline tuberculosis status (89.1%, n = 302), and suppressed viral load (86.5%, n = 360) and had no co-morbidity (91%, n = 402). Overall, 25 (5.6%) were lost to follow-up. Factors independently associated with LTFU were being male (aHR: 2.6, 95% CI: 1.1-6.1, P = 0.03) and receiving care from HC IV (aHR: 3.0, 95% CI: 1.0-8.8, P = 0.04).

Conclusions

LTFU among South Sudanese refugees with HIV in Uganda is substantial. Routine use of patient address locator forms, and improved quality of HIV care at HC IV and men-targeted outreaches and community involvement may reduce LTFU among refugees living with HIV.