Predictors of Mortality among Patients Lost to Follow up Antiretroviral Therapy

Putu Dian Prima Kusuma Dewi, Gede Budi Widiarta

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Introduction: The death of HIV/AIDS patients after receiving therapy in Bali is the seventh highest percentage of deaths in Indonesia. LTFU increases the risk of death in PLHA, given the saturation of people with HIV taking medication. The level of consistency in the treatment is very important to maintain the resilience and quality of life of people living with HIV. This study aims to determine the incidence rate, median time and predictors of death occurring in LTFU patients as seen from their sociodemographic and clinical characteristics.

Methods: This study used an analytical longitudinal approach with retrospective secondary data analysis in a cohort of HIV-positive patients receiving ARV therapy at the Buleleng District Hospital in the period 2006-2015. The study used the survival analysis available within the STATA SE 12 software

Results: The result showed that the incidence rate of death in LTFU patients was 65.9 per 100 persons, with the median time occurrence of 0.2 years (2.53 months). The NNRTI-class antiretroviral evapirens agents were shown to increase the risk of incidence of death in LTFU patients 3.92 times greater than the nevirapine group (HR 3.92; p = 0.007 (CI 1.46-10.51). Each 1 kg increase in body weight decreased the risk of death in LTFU patients by 6% (HR 0.94; p = 0.035 (CI 0.89-0.99).

Conclusion: An evaluation and the monitoring of patient tracking with LTFU should be undertaken to improve sustainability. Furthermore, an observation of the LTFU patient's final condition with primary data and qualitative research needs to be done so then it can explore more deeply the reasons behind LTFU.


hiv/aids; buleleng district hospital; survival analysis

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Alvarez-Uria, G., Naik, P. K., Pakam, R., & Midde, M. (2013). Factors associated with attrition, mortality, and loss to follow up after antiretroviral therapy initiation: data from an HIV cohort study in India. Global Health Action, 6, 21682. Retrieved from / (Accessed: October 01, 2017).

ASEAN. (2011). ASEAN Declaration of Commitment: Getting To Zero New HIV Infection, Zero Discrimination, Zero AIDS-Related Deaths., 1–9.

Bekolo, C. E., Webster, J., Batenganya, M., Sume, G. E., & Kollo, B. (2013). Trends in mortality and loss to follow-up in HIV care at the Nkongsamba Regional hospital, Cameroon. BMC Research Notes, 6(1), 512.

Berheto Tezera Moshago, Demissew Berihun Haile, and S. M. (2014). Predictors of Loss to follow-up in Patients Living with HIV/AIDS after Initiation of Antiretroviral Therapy. North American Journal Of Medical Sciences, 6(9), 453–459. Retrieved from /(Accessed: October 01, 2017).

Cornell, M., Lessells, R., Fox, M. P., Garone, D. B., Giddy, J., Fenner, L., … Boulle, A. (2014). Mortality Among Adults Transferred and Lost to Follow-up From Antiretroviral Therapy Programmes in South Africa: A Multicenter Cohort Study. Journal Acquir Immune Defic Syndrom, 67(2), e67–e75.

Dalal, R. P., Macphail, C., Mqhayi, M., Wing, J., Feldman, C., Chersich, M. F., & Venter, W. D. F. (2008). Characteristics and outcomes of adult patients lost to follow-up at an antiretroviral treatment clinic in johannesburg, South Africa. Journal of Acquired Immune Deficiency Syndromes (1999), 47(1), 101–7.

Denise, E., Mhairi, M., & Ian, S. (2013). Increased risk of mortality and loss to follow-up among HIVpositive patients with oropharyngeal candidiasis and malnutrition prior to ART initiation – A retrospective analysis from a large urban cohort in Johannesburg, South Africa. National Institutes of Health, 1–18.

Deribe, K., Hailekiros, F., Biadgilign, S., Amberbir, A., & Beyene, B. K. (2008). Defaulters from antiretroviral treatment in Jimma University Specialized Hospital, Southwest Ethiopia. Tropical Medicine & International Health : TM & IH, 13(3), 328–33.

Edwards, J. K., Cole, S. R., Westreich, D., Moore, R., Mathews, C., Geng, E., … Mugavero, M. J. (2014). Loss to clinic and five-year mortality among HIV-infected antiretroviral therapy initiators. PloS One, 9(7), e102305.

Fox, M. P., Brennan, A., Maskew, M., MacPhail, P., & Sanne, I. (2010). Using vital registration data to update mortality among patients lost to follow-up from ART programmes: Evidence from the Themba Lethu Clinic, South Africa. Tropical Medicine and International Health.

Haile, K. T. and F., & Mekelle. (2014). Predictors of Loss to Follow Up of Patients Enrolled on Antiretroviral Therapy: A Retrospective Cohort Study. Journal of AIDS & Clinical Research, 5(12).

Hønge, B. L., Jespersen, S., Nordentoft, P. B., Medina, C., da Silva, D., da Silva, Z. J., … Wejse, C. (2013). Loss to follow-up occurs at all stages in the diagnostic and follow-up period among HIV-infected patients in Guinea-Bissau: a 7-year retrospective cohort study. BMJ Open, 3(10), e003499.

Kate Clouse, Audrey Pettifor, Mhairi Maskew, Jean Bassett, Annelies Van Rie, Cyinthia Gay, Frieda Behets, lan Sanne, and M. P. F. (2014). Initiating ART when presenting with higher CD4 counts results in reduced loss to follow-up in a resource-limited setting, 27(4), 645–650.

Kemenkes RI. (2011). Pedoman Nasional Tatalaksana Klinis Infeksi HIV dan Terapi Antiretroviral Pada Orang Dewasa.

Kemenkes RI. (2014). Laporan Situasi Perkembangan HIV&AIDS di Indonesia Tahun 2014.

Lebouche, B., Yazdanpanah, Y., Gerard, Y., Sissoko, D., Ajana, F., Alcaraz, I., Mouton, Y. (2006). Incidence rate and risk factors for loss to follow-up in a French clinical cohort of HIV-infected patients from January 1985 to January 1998, 140–145.

Lwanga, S. K.; Lemeshow, S. (1991). Sample size determination in health studies: a practical manual.

Mocroft, A., Kirk, O., Aldins, P., Chies, A., Blaxhult, A., Chentsova, N., Lundgren, J. D. (2008). Loss to follow-up in an international, multicentre observational study. HIV Medicine, 9(5), 261–9.

Mugisha, V., Teasdale, C. a, Wang, C., Lahuerta, M., Nuwagaba-Biribonwoha, H., Tayebwa, E., … Abrams, E. J. (2014). Determinants of mortality and loss to follow-up among adults enrolled in HIV care services in Rwanda. PloS One, 9(1), e85774.

Ndiaye, B., Ould, K., Salleron, J., Bataille, P., Bonnevie, F., Cochonat, K., … Yazdanpanah, Y. (2009). Original article Incidence rate and risk factors for loss to follow-up in HIV-infected patients from five French clinical centres in Northern France – January 1997 to December 2006, (December 2006), 567–575.

Ochieng-Ooko, V., Ochieng, D., Sidle, J. E., Holdsworth, M., Wools-Kaloustian, K., Siika, A. M., … Braitstein, P. (2010). Influence of gender on loss to follow-up in a large HIV treatment programme in western Kenya. Bulletin of the World Health Organization, 88(9), 681–8.

Odafe, S., Idoko, O., Badru, T., Aiyenigba, B., Suzuki, C., Khamofu, H., … Chabikuli, O. N. (2012a). Patients’ demographic and clinical characteristics and level of care associated with lost to follow-up and mortality in adult patients on first-line ART in Nigerian hospitals. Journal of the International AIDS Society.

Odafe, S., Idoko, O., Badru, T., Aiyenigba, B., Suzuki, C., Khamofu, H., … Chabikuli, O. N. (2012b). Patients’ demographic and clinical characteristics and level of care associated with lost to follow-up and mortality in adult patients on first-line ART in Nigerian hospitals. Journal of the International AIDS Society, 15(2), 17424. Retrieved from October 01, 2017).

Somi, G., Keogh, S. C., Todd, J., Kilama, B., Wringe, a, van den Hombergh, J., … Zaba, B. (2012). Low mortality risk but high loss to follow-up among patients in the Tanzanian national HIV care and treatment programme. Tropical Medicine & International Health : TM & IH.

Sugiyono. (2011). Statistika untuk Penelitian. Bandung.

Tran, D. A., Ngo, A. D., Shakeshaft, A., Wilson, D. P., Doran, C., & Zhang, L. (2013a). Trends in and Determinants of Loss to Follow Up and Early Mortality in a Rapid Expansion of the Antiretroviral Treatment Program in Vietnam: Findings from 13 Outpatient Clinics. PLoS ONE.

Tran, D. A., Ngo, A. D., Shakeshaft, A., Wilson, D. P., Doran, C., & Zhang, L. (2013b). Trends in and determinants of loss to follow up and early mortality in a rapid expansion of the antiretroviral treatment program in Vietnam: findings from 13 outpatient clinics. PloS One, 8(9), e73181.

UNAIDS. (2012). UNAIDS World AIDS Day Report | 2012.

UNAIDS. (2013a). Global Update On HIV Treatment 2013 :, (June).

UNAIDS. (2013b). HIV in Asia and the Pasific. Retrieved from

WHO. (2013). Consulidated Guidelines on The Use Of Antiretroviral Drugs For Treating And Preventing HIV Infection Recommendations For A Public Health Approach, (June).

Wubshet, M., Berhane, Y., Worku, A., & Kebede, Y. (2013). Death and seeking alternative therapy largely accounted for lost to follow-up of patients on ART in northwest Ethiopia: a community tracking survey. PloS One, 8(3), e59197.

Zhou, J., Tanuma, J., Chaiwarith, R., Lee, C. K. C., Law, M. G., Kumarasamy, N., … Lim, P. L. (2012). Loss to Followup in HIV-Infected Patients from Asia-Pacific Region: Results from TAHOD. AIDS Research and Treatment, 2012, 375217.


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