Long-Term Follow-Up Cares and Check Initiative: A Program to Advance Long-Term Follow-Up in Newborns Identified with a Disease through Newborn Screening.

In the United States and around the world, newborns are screened on a population basis for conditions benefiting from pre-symptomatic diagnosis and treatment. The number of screened conditions continues to expand as novel technologies for screening, diagnosing, treating, and managing disease are discovered. While screening all newborns facilitates early diagnosis and treatment, most screened conditions are treatable but not curable. Patients identified by newborn screening often require lifelong medical management and community support to achieve the best possible outcome. To advance the long-term follow-up of infants identified through newborn screening (NBS), the Long-Term Follow-up Cares and Check Initiative (LTFU-Cares and Check) designed, implemented, and evaluated a system of longitudinal data collection and annual reporting engaging parents, clinical providers, and state NBS programs. The LTFU-Cares and Check focused on newborns identified with spinal muscular atrophy (SMA) through NBS and the longitudinal health information prioritized by parents and families. Pediatric neurologists who care for newborns with SMA entered annual data, and data tracking and visualization tools were delivered to state NBS programs with a participating clinical center. In this publication, we report on the development, use of, and preliminary results from the LTFU-Cares and Check Initiative, which was designed as a comprehensive model of LTFU. We also propose next steps for achieving the goal of a national system of LTFU for individuals with identified conditions by meaningfully engaging public health agencies, clinicians, parents, families, and communities.

Incidence and predictors of loss to follow-up among adult patients receiving antiretroviral therapy in Central Ethiopia: a multi-center retrospective cohort study.

Background: Globally, loss to follow-up (LTFU) remains a significant public health concern despite the rapid expansion of antiretroviral medication programs. It is a significant cause of treatment failure and threatens the enhancement of HIV treatment outcomes among patients on antiretroviral therapy (ART). However, there is a paucity of evidence on its incidence and predictors in Ethiopia. Thus, this study aimed to examine the incidence and predictors of LTFU among adult HIV patients receiving ART at hospitals in Central Ethiopia. Methods: A multi-centered facility-based retrospective cohort study was conducted among 432 randomly selected adult patients who received antiretroviral therapy. Data were entered into EpiData version 3.1 and exported to Stata version 14 for analysis. The Kaplan-Meier failure function was employed to determine the overall failure estimates, and the log-rank test was used to compare the probability of failure among the different categories of variables. The Cox proportional hazard model was used to identify independent predictors of LTFU. Results: Overall, 172 (39.8%) study participants were lost to follow-up over the 10-year follow-up period with an incidence rate of 8.12 (95% CI: 7.11, 9.09) per 1,000 person-months. Undisclosed HIV status (AHR: 1.96, 95% CI: 1.14, 3.36), not able to work (AHR: 1.84, 95% CI: 1.13, 2.22), opportunistic infections (AHR: 3.13, 95% CI: 2.17, 4.52), CD4 < 200 cell/mL (AHR: 1.95, 95% CI: 1.18, 3.21), not receiving isoniazid preventive therapy (IPT) (AHR: 2.57, 95% CI: 1.62, 4.06), not participating in clubs (AHR: 1.68, 95% CI: 1.10, 2.22), side effects of drugs (AHR: 1.44, 95% CI: 1.02, 2.04), and high viral load (AHR: 3.15, 95% CI: 1.81, 5.47) were identified as significant predictors of loss to follow-up. Conclusion: In this study, the incidence of LTFU was high. The focus should be on creating awareness and prevention programs that aim to reduce loss to follow-up by continuing counseling, especially on the negative effects of loss to follow-up and the benefits of ART care.

Incidence and predictors of loss to follow-up among Ethiopian children on antiretroviral therapy: a systematic review and meta-analysis.

INTRODUCTION: Loss of follow-up (LTFU) from ART regular follow-up is one of the key acknowledged causes for the development of ART-resistant virus strains currently. It becomes a major weakness for the successful implementation of HIV care and treatment programs mainly in Sub-Saharan Africa but also globally. About 20-40% of children on ART loss their regular ART follow-up annually. Because of the inconsistency of the prior publications' findings, policymakers, programmers, and healthcare providers find it difficult to intervene. Hence, this study was conducted to provide a pooled incidence and identify the predictors of LTFU among children on ART in Ethiopia. METHODS: Articles were searched from PubMed/ MEDLINE, CINAHL, EMBASE, Google Scholar, and Science Direct, as well as organizational records and websites. This review included both retrospective and prospective follow-up studies published in English. The data were extracted using Microsoft Excel and exported into Stata™ Version 17.0 for further processing and analysis. The presence of heterogeneity was assessed using forest plots with the I2 test. To identify the source of heterogeneity subgroup analysis, meta-regression, publication bias, and sensitivity analysis were computed. The pooled incidence of LTFU was estimated using a random effects meta-analysis model with the DerSimonian-laired method. To identify the predictors, a 95% confidence interval with relative risk was used to declare the presence or absence of an association. RESULTS: In this systematic review and Meta-analysis, nine studies with a total of 3336 children were included. The pooled incidence of LTFU from ART was 5.83 (95% CI: 3.94, 7.72) per 100 children-years of observation with I2: 83% & p-value < 0.001. Those children who were from rural were had a 1.65 (95% CI: 1.06, 2.52) times higher chance of getting LTFU when compared with their counterparts. Children who had poor ART adherence had a 2.03 (95% CI: 1.23, 3.34) times higher chance of experiencing LTFU of ART than children having good ART adherence. CONCLUSIONS: Among Ethiopian children on ART, one out of 167 had the risk of experiencing LTFU. Being rural dwellers and having poor ART adherence were the identified predictors of LTFU. Close follow-up and phone message text should be used to have good ART adherence among rural dwellers to meet the predetermined goal of ART.

Interventions to reduce loss to follow up in common retinal pathology: A systematic review.

PURPOSE: Loss to follow-up or fragmented follow-up episodes (LTFU) may contribute to suboptimal clinical outcomes, especially when comparing real world data to clinical trials. This systemic review gathers available evidence around interventions meant to decrease the LTFU in AMD, RVO, and DME patients. PATIENTS AND METHODS: PubMed was queried using a literature search strategy and reviewed by the authors. Studies with interventions aimed at reducing lost to follow up were included. RESULTS: Ten studies were extracted from 89 candidate publications. DISCUSSION: Telephone interventions featuring assistance in scheduling in improving LTFU in urban, African American populations over 50 years old with diabetic retinopathy. The same interventions have shown promise in glaucoma, but remain understudied in AMD, RVO, and other geographic, ethnic, and socioeconomic demographics. CONCLUSION: No sole intervention with efficacy in improving LTFU has been developed. A standardized definition of LTFU, as well as testing interventions across broad age, geography, ethnic, racial, and socioeconomic lines. Longitudinal data would also add credence to the efficacy of purported interventions. OTHER: No sources of funding for this article.

TB treatment non-adherence in São Tomé and Príncipe.

SETTING: Sao Tomé and Principe (STP) is a lower middle-income country in the Gulf of Guinea that has a persistent high loss of TB patients on treatment. OBJECTIVE: To investigate factors associated with patient loss to follow-up (LTFU) and to assess health worker perceptions on non-adherence. DESIGN: A retrospective cohort study was conducted using data from the national database. Factors associated with LTFU were investigated using univariable and multivariable logistic regression. In-depth interviews were conducted with TB health workers to identify perceived barriers for treatment completion. RESULTS: A total of 822 registered patients with drug-susceptible TB were included, of whom 82 (10.0%) were lost to follow-up. Male sex (adjusted OR [aOR] 1.7, 95% CI 1.0-3.0; P = 0.048), as well as living in the Mé-Zóchi and Caué Districts (aOR 2.60, 95% CI 1.58-4.26; P < 0.001) were associated with an increased odds of LTFU. The main barriers to treatment completion were related to lack of food, stigma, and lack of patient information and personal support. CONCLUSION: The study indicates the need to address multiple issues related to LTFU during TB treatment. Enhanced efforts to personalise care, especially for information, nutrition and encouragement will better support patients in STP.

CONTEXTE: Sao Tomé-et-Principe (STP) est un pays à revenu moyen inférieur situé dans le golfe de Guinée qui présente une perte élevée et persistante de patients tuberculeux sous traitement. OBJECTIF: Étudier les facteurs associés à la perte de patients en cours de suivi (LTFU) et évaluer les perceptions des travailleurs de la santé sur la non-observance. MÉTHODE: Une étude de cohorte rétrospective a été réalisée à partir des données de la base nationale. Les facteurs associés à la LTFU ont été étudiés au moyen d'une régression logistique univariable et multivariable. Des entrevues en profondeur ont été menées auprès de travailleurs de la santé spécialisés dans la TB afin de déterminer les obstacles perçus à l'achèvement du traitement. RÉSULTATS: Au total, 822 patients enregistrés atteints de TB pharmacosensible ont été inclus, dont 82 (10,0%) ont été perdus de vue. Le sexe masculin (OR ajusté [ORa] 1,7 ; IC 95% 1,0­3,0 ; P = 0,048), ainsi que le fait de vivre dans les districts de Mé-Zóchi et de Caué (ORa 2,60 ; IC 95% 1,58­4,26 ; P < 0,001) étaient associés à une probabilité accrue d'abandon du traitement. Les principaux obstacles à l'achèvement du traitement étaient liés au manque de nourriture, à la stigmatisation et au manque d'information et de soutien personnel des patients. CONCLUSION: L'étude indique qu'il est nécessaire de s'attaquer aux multiples problèmes liés à LTFU pendant le traitement de la TB. Des efforts accrus pour personnaliser les soins, notamment en matière d'information, de nutrition et d'encouragement, permettront de mieux soutenir les patients en STP.

Factors Contributing to Loss to Follow-Up from HIV Care Among Men Living with HIV/AIDS in Kibaha District, Tanzania.

Purpose: Human immunodeficiency virus/acquired immune deficiency syndrome (HIV/AIDS) remains a global public health challenge and epidemic disease in sub-Saharan African (SSA) countries. Retention in HIV care should be emphasized to reach", 95-95-95" the Joint United Nations Program on HIV/AIDS (UNAIDS) target by 2030. In Tanzania, in spite of existing strategies to ensure retention, loss to follow-up (LTFU) among HIV-infected men is still a common challenge. With limited studies focusing on men's population, little is known on their perspectives on factors contributing to LTFU. This study aimed to explore factors contributing to LTFU among men living with HIV/AIDS in the Kibaha district and to try to formulate strategies that work for men. Methods: The qualitative study using a phenomenological approach was conducted among 16 men with experience in LTFU from three HIV care and treatment clinics located in the Kibaha district. Purposive sampling was used to select informants for semi-structured in-depth interviews from August to December, 2021. The collected data was analyzed thematically. Results: The findings were grouped into three themes which highlightedthe contribution of individual factors, socio-economic factors and health system factors. These factors include anticipated HIV-related stigma, lack of disclosure of their HIV status to their partners, poor knowledge on HIV care, unbearable antiretroviral (ART) medication side effects, sharing of ART medications with their partners, perceived good health status, financial difficulties, work-related travels, demanding employment schedules, spiritual belief in faith healing, poor conduct among healthcare workers and loss of Care and Treatment Clinic (CTC) cards hindered their use of ART services at clinics. Conclusion: The findings from this study revealed linked multi-level factors that influence LTFU from HIV care among HIV-infected men. In order to retain men in HIV care, tailored intervention approaches should be formulated.

Factors associated with treatment outcomes of patients with drug-resistant tuberculosis in China: A retrospective study using competing risk model.

Objectives: Drug-resistant tuberculosis remains a serious public health problem worldwide, particularly in developing countries, including China. This study determined treatment outcomes among a cohort in Guangzhou, China, and identified factors associated with them. Methods: We initiated a retrospective study using drug-resistant TB data in Guangzhou from 2016 to 2020, managed by Guangzhou Chest Hospital. A competing risk model was used to identify the factors associated with treatment failure and death, as well as loss to follow-up (LTFU). Results: A total of 809 patients were included in the study, of which 281 were under treatment. Of the remaining 528 who had clear treatment outcomes, the number and proportion of treatment success, treatment failure, death, and LTFU were 314 (59.5%), 14 (2.7%), 32 (6.0%), and 168 (31.8%), respectively. Being older and having cavities involving the upper lungs were risk factors for treatment failure and death, while non-Guangzhou household registration and interprovincial mobility were risk factors associated with LTFU. Conclusion: Treatment failure and death were significantly associated with cavitation in the lungs, and LTFU was significantly associated with household registration and geographical mobility. Early identification of factors associated with different treatment outcomes is extremely important for policymakers, health experts, and researchers to implement appropriate strategies and measures to treat and manage the TB-infected population in China.

Loss to Follow-Up Risk among HIV Patients on ART in Zimbabwe, 2009-2016: Hierarchical Bayesian Spatio-Temporal Modeling.

Loss to follow-up (LTFU) is a risk factor for poor outcomes in HIV patients. The spatio-temporal risk of LTFU is useful to identify hotspots and guide policy. Secondary data on adult HIV patients attending a clinic in provinces of Zimbabwe between 2009 and 2016 were used to estimate the LTFU risk in each of the 10 provinces. A hierarchical Bayesian spatio-temporal Poisson regression model was fitted using the Integrated Nested Laplace Approximation (INLA) package with LTFU as counts adjusting for age, gender, WHO clinical stage, tuberculosis coinfection and duration on ART. The structured random effects were modelled using the conditional autoregression technique and the temporal random effects were modelled using first-order random walk Gaussian priors. The overall rate of LTFU was 22.7% (95%CI: 22.6/22.8) with Harare (50.28%) and Bulawayo (31.11%) having the highest rates. A one-year increase in the average number of years on ART reduced the risk of LTFU by 35% (relative risk (RR) = 0.651; 95%CI: 0.592-0.712). In general, the provinces with the highest exceedance LTFU risk were Matabeleland South and Matabeleland North. LTFU is one of the drawbacks of HIV prevention. Interventions targeting high-risk regions in the southern and northern regions of Zimbabwe are a priority. Community-based interventions and programmes which mitigate LTFU risk remain essential in the global HIV prevention campaign.

Optimal Follow-Up Duration for Assessment of Birth Defects After In Vitro Fertilization-Embryo Transfer: A Multicenter 5-Year Cohort Study in China.

Objective: To investigate the impact of a 5-year follow-up on the incidence of identified birth defects in children conceived using assisted reproductive technologies (ART). Methods: A 5-year cohort study was performed in three ART centers from January 2013 to October 2018. 1,543 women with 1,985 infants who delivered successfully or underwent termination of pregnancy due to malformations were recruited in this study. Follow-up was conducted by phone interview, 7 days, 1 year, 3 years, and 5 years after birth. Collected data included whether one or more birth defects were diagnosed, the category of birth defects, and when the malformation was diagnosed. Cumulative incidence of birth defects and the loss to follow-up rate of each follow-up was compared. Results: According to the diagnostic criterion of birth defects, 111 cases of one or more birth defects were recorded, with a total of 117 birth defects after the 5-year follow-up. 0.2% (4/1,985) of birth defects were diagnosed before delivery; 2.7% (54/1,985) at 7 days; 5.0% (100/1,985) after 1 year; 5.5% (109/1,985) after 3 years; and 5.6% (111/1,985) after 5 years. 3.4% (4/117) of defects were diagnosed prenatally, 45.3% (53/117) of defects diagnosed within the first 7 days after delivery, 40.2% (47/117) diagnosed during 7 days to 1 year, and 9.4% (11/117) of defects diagnosed in 1-3 years after birth. The remaining 1.7% (2/117) of defects were diagnosed between the ages of 3 and 5 years. Among the 1,543 patients, 99.9% patients (1,542/1,543) responded to the telephone interview at 7 days after delivery; the response rate was 89.0% (1,373/1,543) at 1 year, 81% (1,250/1,543) at 3 years, and 64.5% (995/1,543) after 5 years. Conclusion: We suggest that in ART, 1-year follow-up should be the minimum requirement and 3-year follow up the optimal length of follow-up that balances resource requirements with ascertainment completeness.

Adherence to long-term follow-up preventive practices in allogeneic hematopoietic cell transplantation survivors from North India.

Introduction: There are existing international guidelines for long-term follow-up (LTFU) care of allogeneic hematopoietic cell transplantation (allo-HCT) survivors. However, implementing these guidelines represents a unique challenge in resource-challenged settings. Methods: This study aimed to evaluate adherence to recommended surveillance in allo-HCT survivors at an academic center in North India and study the incidence of late effects. This single-center, retrospective study analyzed records of allo-HCT recipients from 2016 to 2020. Survivors were screened in our LTFU clinic at day +100 and +365 using cardiometabolic parameters (screening for hypertension, dyslipidemia, hyperglycemia, 24-hour urine protein, thyroid function), pulmonary function test (PFT), bone mineral density (BMD), and initiation of revaccination. Results: A total of 40/80 (50%) allo-HCT survivors were alive at a median of 888 days (IQR 515-1,306). The adherence to home-based screening parameters such as blood pressure and blood glucose was highest (>75%), followed by lab-based parameters (45-70%), and lowest for specialized tests such as PFT (<50%) at both day +100 and +365 time points. Adherence to the initiation of revaccination was only 67%. At least one cardiometabolic parameter was out of range in 55% and 63% of survivors at day +100 and +365, respectively. Conclusion: The adherence to recommended surveillance measures for allo-HCT survivors in an academic LTFU clinic at one year was only 75% overall. Cardiometabolic abnormalities were noted in more than half of the survivors. This study emphasizes the need for a structured LTFU clinic in all centers performing HCT.

High risk of unsuccessful treatment outcome in migrant population with tuberculosis: Data from three Italian hospitals.

Introduction: Tuberculosis (TB) remains an unresolved global health problem and vulnerable groups such as migrants remain the most affected with a higher risk of worse outcomes. The aim of this study was to evaluate clinical features, outcomes, and adverse events in migrant and native Italian patients admitted to three Italian hospitals in Southern Italy in order to assess differences and targeted strategies. Methods: We performed a retrospective study on TB patients admitted between January 1, 2013, and December 31, 2021, in three Apulia hospitals. Two logistic regression models were used, with the dependent variables being (I) unsuccessful treatment (died, loss to follow-up, and failed treatment) and (II) adverse events. Results: We enrolled 543 consecutive patients admitted at three Italian hospitals with a diagnosis of TB during the study period, of them 323 (59.5%) were migrants and 220 Italian patients. The treatment success rate in the migrant group was 44.9% (137/305), while in the non-migrant group was 97.1% (203/209). Independent factors of unsuccess treatment (death, failure or loss to follow up) were: migrant status (O.R. = 11.31; 95% CI 9.72-14.23), being male (O.R. = 4.63; 95% CI 2.16-6.10), homelessness (O.R. = 3.23; 95% CI 2.58-4.54), having a MDR (Multidrug-resistant) (O.R = 6.44; 95% CI 4.74-8.23), diagnostic delay (O.R. = 3.55; 95% CI 1.98-5.67), and length of hospitalization (O.R. = 3.43; 95% CI 1.88-5.87). While, age >65 ys (O.R. = 3.11; 95% CI 1.42-4.76), presence of extrapulmonary TB (O.R. = 1.51; 95% CI 1.31-2.18), monoresistance (O.R. = 1.45; 95% CI 1.25-3.14) and MDR pattern (O.R. = 2.44; 95% CI 1.74-5.03) resulted associated with adverse events. Conclusion: Migrant population is at high risk of unsuccessful treatment (death, loss to follow-up, and treatment failure). Policies targeted specifically to this group are needed to really impact and improve their health status and also to contain the TB burden.

Factors associated with an interruption in treatment of people living with HIV in USAID-supported states in Nigeria: a retrospective study from 2000-2020.

BACKGROUND: Patient interruption of antiretroviral therapy (ART) continues to limit HIV programs' progress toward epidemic control. Multiple factors have been associated with client interruption in treatment (IIT)- including age, gender, CD4 count, and education level. In this paper, we explore the factors associated with IIT in people living with HIV (PLHIV) in United States Agency for International Development (USAID)-supported facilities under the U.S. President's Emergency Plan for AIDS Relief (PEPFAR) program in Nigeria. METHODS: We conducted cross-sectional analyses on data obtained from Nigeria's National Data Repository (NDR), representing a summarized record of 573 630 ART clients that received care at 484 PEPFAR/USAID-supported facilities in 16 states from 2000-2020. IIT was defined as no clinical contact for 28 days or more after the last expected clinical contact. Univariate and multivariate logistic regression models were computed to explore the factors associated with IIT. The variables included in the analysis were sex, age group, zone, facility level, regimen line, multi-month dispensing (MMD), and viral load category. RESULTS: Of the 573 630 clients analysed in this study, 32% have been recorded as having interrupted treatment. Of the clients investigated, 66% were female (32% had interrupted treatment), 39% were aged 25-34 at their last ART pick-up date (with 32% of them interrupted treatment), 59% received care at secondary level facilities (37% interrupted treatment) and 38% were last receiving between three- to five-month MMD (with 10% of these interrupted treatment). Those less likely to interrupt ART were males (aOR = 0.91), clients on six-month MMD (aOR = 0.01), adults on 2nd line regimen (aOR = 0.09), and paediatrics on salvage regimen (aOR = 0.02). Clients most likely to interrupt ART were located in the South West Zone (aOR = 1.99), received treatment at a tertiary level (aOR = 12.34) or secondary level facilities (aOR = 4.01), and had no viral load (VL) on record (aOR =10.02). Age group was not significantly associated with IIT. CONCLUSIONS: Sex, zone, facility level, regimen line, MMD, and VL were significantly associated with IIT. MMD of three months and longer (especially six months) had better retention on ART than those on shorter MMD. Not having a VL on record was associated with a considerable risk of IIT.

Real-world adherence to topical therapies in patients with moderate acne.

BACKGROUND: Real-life data on topical treatments in daily practice in patients with moderate acne are poorly characterized. OBJECTIVE: To investigate the drug survival of topical treatments administered to patients with moderate acne in a daily practice. METHODS: Survival analysis was performed on subjects (Belgian university hospital and private practice outpatient dermatology patients) with moderate acne who received topical therapies according to the current published guidelines. RESULTS: A total of 1160 treatment series (1029 patients) were included, including benzoyl peroxide (BPO, n = 93), azelaic acid (n = 246), adapalene (n = 254), a fixed combination of adapalene 0.1% and BPO 2.5% (A/BPO, n = 264), and a fixed combination of clindamycin 1.2% and tretinoin 0.025% gel (Clin-RA, n = 303). The calculated overall median treatment duration of all drugs was 2 months. The probability of treatment discontinuation after only 3 months was 50%. Overall, the drugs were discontinued for the following reasons: controlled acne (9%), side effects (9%), ineffectiveness (52%), combination of side effects and ineffectiveness (3%), and other reasons (1%). Overall, 27% patients were lost to follow-up. LIMITATIONS: The post hoc study design and generalizability limit interpretation of the data. CONCLUSION: Overall, the median treatment duration of topical anti-acne therapies was short (2 months). The main reason for discontinuation was ineffectiveness.

Project "Backtoclinic I": An overview on the state of care of adult PKU patients in Austria.

BACKGROUND: High rates of lost to follow-up (LTFU) adult patients are a major concern in the long-term management of phenylketonuria (PKU). To address this issue, we designed the project "Backtoclinic" with the purpose of identifying LTFU adult PKU patients in Austria as a first step to reestablish appropriate treatment. SUBJECTS AND METHODS: Individuals born between 1966 and 1999 and diagnosed with PKU through the National Austrian Newborn Screening Program (NANSP) were identified using the NANSP's database. Follow-up data were collected in the Austrian metabolic centers (Medical University of Vienna, Graz, Innsbruck and Salzburg). Patients with no contact to any of these centers within the previous two years were classified as LTFU. Epidemiological characteristics of the whole study population as well as of LTFU- and currently in follow-up patients were analyzed. RESULTS: Between 1966 and 1999, 281 individuals were diagnosed with PKU through the NANSP. Two patients died in their first year of life and were excluded from the analysis. Of the remaining 279 patients (mean age ± SD: 36.7 ± 9.1 y, 42.7% females), 177 (63.4%) are currently LTFU. The rate of LTFU patients is higher in men than in women (68.1% vs 57.5%), and markedly increases with age in both sexes. The gender gap is greatest in young adults (52.6% vs. 25.0% in the age range 20.0-24.9 y) and declines with age (94.4% vs. 80.0% in the age range > 45.0 y). CONCLUSIONS: We found an alarming rate of 63.4% of LTFU adult PKU patients in Austria, and observed a gender gap in the PKU state of care. Our findings illustrate the urgent need for the metabolic community to identify LTFU adult PKU patients and to develop strategies to reestablish appropriate treatment for men and women with PKU.

Influence of Lost to Follow Up from Antiretroviral Therapy Among Retroviral Infected Patients at Tuberculosis Centers in Public Hospitals of Benishangul-Gumuz, Ethiopia.

BACKGROUND: Broadening access to healthcare (ART) antiretroviral therapy has led to a 19% reduction in the death rate of people infected with the human immunodeficiency virus. This study would also describe the status and deciding factors of ART in (TB) tuberculosis centers in public hospitals of Benishangul-Gumuz, Ethiopia, for (LTFU) lost follow-up among (RVI) retroviral infected patients. METHODS: Hospital-based, unrivalled analysis of the case management (3:1) design was conducted. A total of 752 study participants (563 controls and 189 cases) Picked by systematic random sampling methodology, and where reviewed their charts from TB Centers. Data were entered and cleaned using Epi data version 3.1.1 and then exported to SPSS version 22 for analysis. To analyze the statistical relationship between the outcome variable and independent variables, binary logistic regression was used. Relevance was declared at a p-value <0.05. RESULTS: A total of 1122 (25.3%) were LTFU. Among index cases with male cases, there were higher odds of lost to follow up (AOR= 1.68, 95% CI; 1.085, 2.609), 15-24 old age group have no formal education, civil servant were also having high comparatively. In index cases with identified parents, the risk of LTFU up had lower HIV status (AOR=0.5; 95% CI; 0.24, 0.997). Rest all variables showed low odds to LTFU. CONCLUSION: A large number of patients enrolled in ARTwere missing from follow-up at TB centers, but unfortunately did not make the next appointment reported. The absence of prophylaxis was accepted as an independent determinant of LTFUfor ART.

Exploring and understanding HCV patient journeys- HEPCARE Europe project.

BACKGROUND: Hepatitis C Virus (HCV) is a leading cause for chronic liver diseases worldwide. The European Union and World Health Organization aspire to eliminate HCV by 2030. However, among at-risk populations, including, homeless people, prisoners and People Who Inject Drugs, access to diagnosis and treatment is challenging. Hepcare Europe is an integrated model of care developed to address this by assessing potential reasons for these restrictions and determining measures needed to improve HCV diagnosis, treatment and access to care within different communities. OBJECTIVES: HepCare Europe is an EU-supported project involving collaboration between five institutions in: Ireland, United Kingdom, Spain and Romania. We aim to explore the journey of care experienced by those living with HCV with a focus on previous care disruptions (loss to follow up) and the new HepCare Europe Programme. METHODS: Research teams conducted semi-structured interviews with patients who accessed services through HepCare Europe thus, patients were recruited by purposeful sampling. Patients interviewed had received, or were in the final weeks of receiving, treatment. The interviews were audio recorded, transcribed and translated into English, and sent to the Dublin team for inductive thematic analysis. Researchers from the HepCare Europe research team coded the data separately, then together. RESULTS: Common themes are introduced to present similarities, following individual site themes to highlight the importance of tailored interventions for each country. Key themes are: 1) Hepatitis C patients lost to follow up 2) HepCare improved access to treatment and 3) the need for improved HCV education. Individual themes also emerged for each site. These are: Ireland: New opportunities associated with achieving Sustained Virologic Responses (SVR). Romania: HCV is comparatively less crucial in light of Human Immunodeficiency Viruses (HIV) coinfections. UK: Patients desire support to overcome social barriers and Spain: Improved awareness of HCV, treatment and alcohol use. CONCLUSION: This study identified how the tailored HepCare interventions enabled improved HCV testing and linkage to care outcomes for these patients. Tailored interventions that targeted the needs of patients, increased the acceptability and success of treatment by patients. HepCare demonstrated the need for flexibility in treatment delivery, and provided additional supports to keep patients engaged and educated on new treatment therapies.

To study the impact of active case finding (ACF) among the TB patients detected in South Delhi.

BACKGROUND: TB is one of the top 10 causes of death worldwide. The WHO adopted the End TB Strategy with ambitious goal of ending the global TB epidemic by 2030. The targets for this were 95% reduction in number of TB deaths, 90% reduction in TB incidence rate between 2015 and 2035 and to ensure that no family is burdened with catastrophic expenditure due to TB. Enhanced case detection is one of the components of End TB strategy adopted by WHO and within this Active Case Finding has an important place. However, its role in the Indian context needs to be assessed. AIMS AND OBJECTIVES: To study the impact of Active Case Finding (ACF) in National Tuberculosis Elimination Program (NTEP) implementing area of National Institute of TB and Respiratory Diseases New Delhi in terms of case detection and treatment outcome. MATERIALS AND METHODS: The TB patients detected during ACF through house to house survey in vulnerable population were identified, evaluated and followed up. Data from ACF records and TB treatment cards were filled in a pretested proforma and compared with passive case detection in the previous month from same area. RESULTS: In December 2017 a total 8600 vulnerable population (living in slums, camps and night shelters) were screened over two weeks of whom 85 were found to have symptoms suggestive of TB of whom 19 were PTB that gives a case detection rate of 220 per lakh population. PTB case detection rate by passive case finding (PCF) in November 2017 from the same area of our study was found to be 63 per lakh population. This difference between the detection rate in ACF and passive case findings was statistically significant with Z proportion test and p value <0.00001. Treatment success rate was 75% and lost to follow up rate was 25% patients among the PTB patients detected in ACF. In passive case detection from the same area in November 2017 treatment success rate was 81.8% and lost to follow up rate (LTFU) was 18% in PTB patients. Even though LTFU rate was slightly higher but was not statistically significant. CONCLUSION: ACF is an effective way to find additional cases of TB. ACF is more labour intensive than PCF but if judiciously used under national programme to target specific vulnerable population of society it can produce additional number of TB cases which otherwise would have gone undiagnosed. However, treatment outcome for these patients is below the target and hence to get the maximum impact of ACF there is a need to enhance the adherence to treatment through different methodologies. Poor treatment adherence will lead to increase transmission risk in communities and greater chance of developing drug resistance. Further studies with larger representative population should be undertaken in order to get more conclusive.

Loss to follow up after pregnancy among mothers enrolled on the option B+ program in Uganda.

Objective: Option-B+ programs in Uganda have reported high levels of loss to follow up (LTFU) after cessation of breastfeeding, and this remains unknown beyond this period. In this study, we assessed the incidence and factors associated with LTFU two to four years after delivery among Option-B+ mothers. Study design: Retrospective cohort. Methods: We reviewed files of 452 mothers who enrolled on Option-B+ between January 1st, 2013 and December 31st, 2014 â€‹at Kisenyi Health Centre IV in Kampala district. We assessed factors associated with LTFU using Cox proportional hazards regression. We also explored the reasons for LTFU using three focus group discussions, five in-depth and three key informant interviews. Results: Of the 452 mothers, 131(29%) were LTFU after delivery. The incidence of LTFU after delivery was 17/1000 person months (95% CI, 14-30/1000) with a median follow up of 32 months. The risk of LTFU was higher among mothers who started ART on the day they tested HIV positive (aHR â€‹= â€‹1.66, 95% CI; 1.25-2.20, p-value< 0.001). Reasons for LFTU included transport costs, stigma, poor human resource policies and non-disclosure. Conclusion: LTFU after delivery among Option-B+ mothers is higher than the global target of 15%. ART initiation on the day a mother tests positive increases the risk of LTFU. The major reasons for LTFU were stigma and non-disclosure. To reduce the risk of LTFU, we recommend approaches that encourage disclosure to sexual partners and ongoing specific support to mothers who are initiated on ART-the day of positive test.

The perceived determinants and recommendations by mothers and healthcare professionals on the loss-to-follow-up in Option B+ program and child mortality in the Amhara region, Ethiopia.

BACKGROUND: The third United Nations Sustainable Development Goal includes a commitment to end AIDS-related death by 2030. In line with the Goal, Option B+ programs hold a great promise for eliminating vertical transmission of HIV. Option B+ was introduced in 2013 in Ethiopia. The Global Plan identified Ethiopia as one of 22 high priority countries requiring improvement in prevention of mother to child HIV transmission services. Despite HIV treatment being free in Ethiopia, only 59% of children are on treatment. The discrepancies in high uptake of Option B+ and low numbers of children in Ethiopia can be attributed to Loss-to-follow-up, which is estimated from 16 to 80%. While LFTU is expected in the region, no-to-minimal evidence exists on the magnitude and its determinants, which hampers the development of interventions and strategies to reduce LFTU. The purpose of this study is to explore perception of mothers and healthcare providers on determinants of and recommendations to reduce LTFU and HIV exposed infants' mortality. METHOD: Explorative, descriptive qualitative study conducted in five zones of Amhara region. The sample consisted of mothers enrolled to the option B+ programs at the five referral hospitals PMTCT departments, nurses and midwives working in those departments, and HIV officers in zonal departments. Data were collected in 2019 using in-depth interviews. Data were analyzed using content analysis and deduced to themes. RESULTS: Overall, nine themes were identified from the interviews. Five themes represented the determinants of LTFU and mortality while four themes addressed the recommendations to reduce LFTU among mothers and their infant mortality. The determinants themes centered on apathy, stigma and discrimination, poor access to services, healthcare providers behavior and attitudes, and social determinants of health. While recommendations themes suggested that improving access, capitalizing on psychosocial support, education and awareness, and empowerment. CONCLUSIONS: Social and structural issues are major contributors to low retention of mothers and death of children due to HIV. A multi-stakeholder approach, including structural changes, are required to support women and their children to ensure that individuals, communities and country enjoy the full benefits of option B+ and lead to an HIV free generation.

HIV-exposed infant follow-up in Mozambique: formative research findings for the design of a cluster randomized controlled trial to improve testing and ART initiation.

BACKGROUND: Early infant diagnosis (EID) of HIV-exposed and initiation of HIV-positive infants on anti-retroviral therapy (ART) requires a well-coordinated cascade of care. Loss-to-follow-up (LTFU) can occur at multiple steps and effective EID is impeded by human resource constraints, difficulty with patient tracking, and long waiting periods. The objective of this research was to conduct formative research to guide the development of an intervention to improve the pediatric HIV care cascade in central Mozambique. The study was conducted in Manica and Sofala Provinces where the adult HIV burden is higher than the national average. The research focused on 3 large clinics in each province, along the highly populated Beira corridor. METHODS: The research was conducted in 2014 over 3 months at six facilities and consisted of 1) patient flow mapping and collection of health systems data from postpartum, child-at-risk, and ART service registries, 2) measurement of clinic waiting times, and 3) patient and health worker focus groups. RESULTS: HIV testing and ART initiation coverage for mothers tends to be high, but EID and pediatric ART initiation are hampered by lack of patient tracking, long waiting times, and inadequate counseling to navigate the care cascade. About 76% of HIV-positive infants were LTFU and did not initiate ART. CONCLUSIONS: Effective interventions to reduce LTFU in EID and improve pediatric ART initiation should focus on patient tracking, active follow-up of defaulting patients, reduction in EID turn-around times for PCR results, and initiation of ART by nurses in child-at-risk services. TRIAL REGISTRATION: Retrospectively registered, ISRCTN67747315, July 24, 2019.