The predictors of loss to follow up among HIV positive patients attending a Bali Clinic. a longitudinal Study.
The predictors of loss to follow
up among HIV positive patients
attending a Bali Clinic; a
longitudinal Study
Desak Nym Widyanthini
Udayana University, Bali, Indonesia
Background
• HIV was first reported from in Indonesia in 1987 and the
number of reported cases continues to increase
• Between 1987 and December 2012 Bali has reported a total
of 9724 cases
• Bali ranks 5th after Jakarta, East Java, Papua, and West Java in
the number of HIV cases
• Antiretroviral Therapy (ART) is now available to reduce
mortality and morbidity and improve quality of life for people
living with HIV
• Successful ART depends on regular and complete patient
follow-up
• The number of new patients starting ART and the number lost
to follow-up are important indicators of program effectiveness
• This study looks at what predicts loss to follow up among
people with HIV
Aims and Objective
• To determine the factors that predict loss to
follow up of HIV patient
• Ultimately to use this information to improve
retention of patients in ARV treatment
Method
• A longitudinal analysis of medical records of HIV patients
attending a clinic between 2002 and December 2012
• Study site: YKP – a non government clinic for high risk
groups located in Denpasar
• Population: high risk groups with a positive HIV test
result
• Inclusion criteria: patients starting ART for the first time
in YKP Clinic.
• Exclusion criteria: patients who die, move away, or only
one time visit YKP
• Analysis method: survival analysis based on time to
follow up or time to loss
• Variables collected from medical records : sex,
occupation, risk of HIV transmission, education,
opportunistic infection, supervisor of ART, age, cd4
absolute, hemoglobin, weight
Preliminary Result
Total population = 545 people
• 68 (12.5%) people was die
• 45 (8.3%) people move away
• 1 (0.2%) people only one time visit YKP
• 80 (14.7%) people lost to follow up
• 351 (64.4%) people no lost to follow up
Total sample = 431 people (lost to follow up and
no lost to follow up)
Data Description (n=431)
Variable
Sex
•Man
•Woman
n (%)
237 (55%)
194 (45%)
Occupation
•Other
•Sex workers
•Missing
323(75.9%)
107 (24.8%)
1 (0.23%)
Risk of HIV transmission
•IDU
•Homosexual
•Heterosexual
•Bisexual
88 (20%
75 (17%)
254 (59%)
14 (3%)
Education
•Senior high school
•Junior high school
•No education,
elementary
OI
•Do ’t have
•Have
201 (47%)
93 (22%)
137 (32%)
371 (86%)
60 (14%)
Variable
n (%)
Supervisor of ARV
•Have
•Do ’t have
281 (65%)
150 (35%)
Age
•≤ 7 yr
•31-36 yr
• 300sel/mm3
383 (89%)
48 (11%)
Hemoglobin
•≤ gr%
•>12-13.7 gr%
•>13.7 gr%
•missing
124 (29%)
165 (38%)
135 (31%)
7 (2%)
Weight
•≤5 kg
•>51-59 kg
•>59 kg
•missing
143 (33%)
140 (32%)
145 (34%)
3 (1%)
Univariate Analysis :
Characteristic
risk of HIV transmission
education
supervisor of ART
IDU
homosexual
heterosexual
bisexual
senior high school
junior high school
no education, elementary
have
do ’t have
Haz. Ratio L95%CI
ref
3.14
1.42
2.71
1.4
5.79
1.59
ref
1.86
1.05
1.99
1.18
ref
1.76
1.11
U95%CI
P
P-group
6.93
5.23
21.09
0.005
0.003
0.008
0.007
3.3
3.35
0.032
0.009
0.022
2.78
0.016
Multivariate Analysis* :
Characteristic
risk of HIV transmission
education
IDU
homosexual
heterosexual
bisexual
senior high school
junior high school
no education, elementary
Haz. Ratio L95%CI U95%CI
ref
3.13
1.41
6.92
0.005
2.34
1.2
4.57
0.012
6.97
2
25.74
0.004
ref
1.82
1.01
3.28
0.045
1.94
1.13
3.32
0.016
P
* Adjusted from sex, supervisor of ART, age, cd4 cell, hemoglobin, and weight
P-group
0.007
0.038
Preliminary Conclusion
The predictors of Lost to Follow Up are :
1. Risk of HIV transmission
2. Education
Implementation :
Concern to related factor that influence the
patient who can be lost to follow up to start an
ART such as with their history of transmission
and more counseling to patients with lower
education
Next Steps
• Make manuscript
Acknowledgement
• Mentors from Kirby Institute
• Mentors from Udayana University
THANK YOU…
up among HIV positive patients
attending a Bali Clinic; a
longitudinal Study
Desak Nym Widyanthini
Udayana University, Bali, Indonesia
Background
• HIV was first reported from in Indonesia in 1987 and the
number of reported cases continues to increase
• Between 1987 and December 2012 Bali has reported a total
of 9724 cases
• Bali ranks 5th after Jakarta, East Java, Papua, and West Java in
the number of HIV cases
• Antiretroviral Therapy (ART) is now available to reduce
mortality and morbidity and improve quality of life for people
living with HIV
• Successful ART depends on regular and complete patient
follow-up
• The number of new patients starting ART and the number lost
to follow-up are important indicators of program effectiveness
• This study looks at what predicts loss to follow up among
people with HIV
Aims and Objective
• To determine the factors that predict loss to
follow up of HIV patient
• Ultimately to use this information to improve
retention of patients in ARV treatment
Method
• A longitudinal analysis of medical records of HIV patients
attending a clinic between 2002 and December 2012
• Study site: YKP – a non government clinic for high risk
groups located in Denpasar
• Population: high risk groups with a positive HIV test
result
• Inclusion criteria: patients starting ART for the first time
in YKP Clinic.
• Exclusion criteria: patients who die, move away, or only
one time visit YKP
• Analysis method: survival analysis based on time to
follow up or time to loss
• Variables collected from medical records : sex,
occupation, risk of HIV transmission, education,
opportunistic infection, supervisor of ART, age, cd4
absolute, hemoglobin, weight
Preliminary Result
Total population = 545 people
• 68 (12.5%) people was die
• 45 (8.3%) people move away
• 1 (0.2%) people only one time visit YKP
• 80 (14.7%) people lost to follow up
• 351 (64.4%) people no lost to follow up
Total sample = 431 people (lost to follow up and
no lost to follow up)
Data Description (n=431)
Variable
Sex
•Man
•Woman
n (%)
237 (55%)
194 (45%)
Occupation
•Other
•Sex workers
•Missing
323(75.9%)
107 (24.8%)
1 (0.23%)
Risk of HIV transmission
•IDU
•Homosexual
•Heterosexual
•Bisexual
88 (20%
75 (17%)
254 (59%)
14 (3%)
Education
•Senior high school
•Junior high school
•No education,
elementary
OI
•Do ’t have
•Have
201 (47%)
93 (22%)
137 (32%)
371 (86%)
60 (14%)
Variable
n (%)
Supervisor of ARV
•Have
•Do ’t have
281 (65%)
150 (35%)
Age
•≤ 7 yr
•31-36 yr
• 300sel/mm3
383 (89%)
48 (11%)
Hemoglobin
•≤ gr%
•>12-13.7 gr%
•>13.7 gr%
•missing
124 (29%)
165 (38%)
135 (31%)
7 (2%)
Weight
•≤5 kg
•>51-59 kg
•>59 kg
•missing
143 (33%)
140 (32%)
145 (34%)
3 (1%)
Univariate Analysis :
Characteristic
risk of HIV transmission
education
supervisor of ART
IDU
homosexual
heterosexual
bisexual
senior high school
junior high school
no education, elementary
have
do ’t have
Haz. Ratio L95%CI
ref
3.14
1.42
2.71
1.4
5.79
1.59
ref
1.86
1.05
1.99
1.18
ref
1.76
1.11
U95%CI
P
P-group
6.93
5.23
21.09
0.005
0.003
0.008
0.007
3.3
3.35
0.032
0.009
0.022
2.78
0.016
Multivariate Analysis* :
Characteristic
risk of HIV transmission
education
IDU
homosexual
heterosexual
bisexual
senior high school
junior high school
no education, elementary
Haz. Ratio L95%CI U95%CI
ref
3.13
1.41
6.92
0.005
2.34
1.2
4.57
0.012
6.97
2
25.74
0.004
ref
1.82
1.01
3.28
0.045
1.94
1.13
3.32
0.016
P
* Adjusted from sex, supervisor of ART, age, cd4 cell, hemoglobin, and weight
P-group
0.007
0.038
Preliminary Conclusion
The predictors of Lost to Follow Up are :
1. Risk of HIV transmission
2. Education
Implementation :
Concern to related factor that influence the
patient who can be lost to follow up to start an
ART such as with their history of transmission
and more counseling to patients with lower
education
Next Steps
• Make manuscript
Acknowledgement
• Mentors from Kirby Institute
• Mentors from Udayana University
THANK YOU…