Factors associated with loss to follow-up among people living with HIV at public health facilities in Manaus, Brazil: a multicentric study

BACKGROUND: Loss to follow-up (LTFU) among people living with HIV (PLHIV) impact on the quality of life of PLHIV, and consequently on the ineffectiveness of strategies to control the HIV/AIDS epidemic. METHODS: The aim of the study was to investigate the factors associated with LTFU among PLHIV treated at health facilities for PLHIV in Manaus. This was a multicenter cohort study that involved the review of medical records in referral units for monitoring PLHIV in the district of Manaus. PLHIV who did not collect ARVs in a period of more than 90 days or did not attend a scheduled appointment in six months were considered LTFU. Sociodemographic, epidemiological, behavioral, diagnostic and clinical follow-up variables of all study participants were analyzed. Cox proportional hazards regression was used to determine factors associated with LTFU. 234 semi-structured interviews were conducted with PLHIV in LTFU status to explore reasons for LTFU. RESULTS: Of the 2085 PLHIV enrolled, 1534 (73.58%) were male, the median age was 36.75 years, and 701 (33.72%) were < 30 years old, 1226 (58.80%) were single, and the majority had a first baseline CD4 count less than 500c/ µ l. A total of 465 (22.30%) become LTFU. The main factors associated with LTFU included being single (hazard ratio (HR) = 3.51, 95% confidence interval (CI): 1.69-7.36, p = 0.01), low education level (HR = 2.1, 95% CI: 0.62-3.36, p = 0.00), and having an undetectable last viral load result (HR = 2.04; 95% CI, 1.05-3.95; p = 0.04). Discrimination, stigma, lack of family or social support, illicit drug use, low economic conditions, adverse effects of antiretroviral therapy, feeling healthy, and poor patient-provider relationship were the main reasons for LTFU reported from semi-structured interviews conducted with PLHIV in LTFU status. CONCLUSIONS: The phenomenon of LTFU among PLHIV is a reality in the health facilities of Manaus. This phenomenon can be predicted based on sociodemographic and clinical characteristics, as well as socioeconomic factors. To effectively reduce LTFU among PLHIV in Manaus, it is recommended to reinforce appropriate measures for risk groups and improve the quality-of-service provision to PLHIV.