Age, education, risk of transmission, and supervison of arv as predictors of loss to follow up among HIV-AIDS patients at a treatment clinic in Bali 2002-2012.
AGE, EDUCATION, RISK OF TRANSMISSION, AND SUPERVISON OF ARV AS PREDICTORS
OF LOSS TO FOLLOW UP AMONG HIV/AIDS PATIENTS AT A TREATMENT CLINIC IN BALI
2002-2012
Desak Nyoman Widyanthini1, Anak Agung Sagung Sawitri1, Luh Putu Lila Wulandari1, Partha
Muliawan1, Yuneti Oktavianus Nyoko1 , Kathy Petoumenos2, Janaki Amin2, Bradley Mathers2, John
Kaldor2, Dewa Nyoman Wirawan1,4
1. Post Graduate Program in Public Health Sciene, Udayana University, Bali, Indonesia
2. The Kirby Institute, The University of New South Wales, Australia
3. Kerti Praja Foundation
ABSTRACT
Background. Successful Antiretroviral Therapy (ART) depends on regular and complete patient
follow-up. The number loss to follow-up is an important indicator of program effectiveness.This study
identified loss to follow-up among HIV positive individuals on ARV treatment in Bali.
Method. Longitudinal analysis of medical records of HIV patients who had started ARV treatment and
attending a voluntary counselling and testing clinic between 2002 and December 2012 at Kerti Praja
Foundation (YKP). Cox Proportional Hazard were used to assess loss to follow up. Variables included
in the analyses were; sex, occupation, mode of HIV transmission, education level, history of
opportunistic infection, if ARV was supervised, age, CD4 count at baseline. Supervison of ARV is
someone in charge of reminding patient to take antiretroviral. Lost to follow-up was defined as when
the patients did not come to seek ART in 3 months at the scheduled visit. Patients were included in
analysis if they had more than one visit YKP clinic.
Result. A total of 549 patients were recorded for an ARV visit between 2002 and 2012. One person
had only one clinic visit leaving 548 eligible study subjects. Of the 548 patients, 77 (14.1%) were lost
to follow up and 471 (85.9%) were retained in treatment, died, or moved away. The median time of
loss to follow up is 1.3 years (IQR=0.3-2.5). In multivariate analysis, patients who didn’t have
supervisor of ART 1.8 times more likely to loss to follow-up (HR=1.8; 95% CI=1.1-2.83; p=0.018).
Patients with history of IDU had less likely to loss to follow-up compare with heterosexual (HR=0.4;
95% CI=0.19-0.71; p=0.003). Patients with lower education and had age above 32 years old less
likely to loss to follow-up [(HR=0.6; 95% CI=0.36-0.97; p=0.037) and (HR=0.6; 95% CI=0.33-0.94;
p=0.029)].
Conclusion. Supervision is needed to improve retention on ARV treatment. Improving adherence
counselling is recommended especially for the patient with higher education, heterosexual, and
younger age. The role of Methadone Maintenance Therapy (MMT) in IDU retention was not examined
and may have influenced adherence.
Keywords : HIV positive individuals, ARV Treatment, Loss to follow up
OF LOSS TO FOLLOW UP AMONG HIV/AIDS PATIENTS AT A TREATMENT CLINIC IN BALI
2002-2012
Desak Nyoman Widyanthini1, Anak Agung Sagung Sawitri1, Luh Putu Lila Wulandari1, Partha
Muliawan1, Yuneti Oktavianus Nyoko1 , Kathy Petoumenos2, Janaki Amin2, Bradley Mathers2, John
Kaldor2, Dewa Nyoman Wirawan1,4
1. Post Graduate Program in Public Health Sciene, Udayana University, Bali, Indonesia
2. The Kirby Institute, The University of New South Wales, Australia
3. Kerti Praja Foundation
ABSTRACT
Background. Successful Antiretroviral Therapy (ART) depends on regular and complete patient
follow-up. The number loss to follow-up is an important indicator of program effectiveness.This study
identified loss to follow-up among HIV positive individuals on ARV treatment in Bali.
Method. Longitudinal analysis of medical records of HIV patients who had started ARV treatment and
attending a voluntary counselling and testing clinic between 2002 and December 2012 at Kerti Praja
Foundation (YKP). Cox Proportional Hazard were used to assess loss to follow up. Variables included
in the analyses were; sex, occupation, mode of HIV transmission, education level, history of
opportunistic infection, if ARV was supervised, age, CD4 count at baseline. Supervison of ARV is
someone in charge of reminding patient to take antiretroviral. Lost to follow-up was defined as when
the patients did not come to seek ART in 3 months at the scheduled visit. Patients were included in
analysis if they had more than one visit YKP clinic.
Result. A total of 549 patients were recorded for an ARV visit between 2002 and 2012. One person
had only one clinic visit leaving 548 eligible study subjects. Of the 548 patients, 77 (14.1%) were lost
to follow up and 471 (85.9%) were retained in treatment, died, or moved away. The median time of
loss to follow up is 1.3 years (IQR=0.3-2.5). In multivariate analysis, patients who didn’t have
supervisor of ART 1.8 times more likely to loss to follow-up (HR=1.8; 95% CI=1.1-2.83; p=0.018).
Patients with history of IDU had less likely to loss to follow-up compare with heterosexual (HR=0.4;
95% CI=0.19-0.71; p=0.003). Patients with lower education and had age above 32 years old less
likely to loss to follow-up [(HR=0.6; 95% CI=0.36-0.97; p=0.037) and (HR=0.6; 95% CI=0.33-0.94;
p=0.029)].
Conclusion. Supervision is needed to improve retention on ARV treatment. Improving adherence
counselling is recommended especially for the patient with higher education, heterosexual, and
younger age. The role of Methadone Maintenance Therapy (MMT) in IDU retention was not examined
and may have influenced adherence.
Keywords : HIV positive individuals, ARV Treatment, Loss to follow up