Page 56 - SAHCS HIVMed Journal Vol 20 No 1 2019

Southern African Journal of HIV Medicine
ISSN: (Online) 2078-6751, (Print) 1608-9693
Page 1 of 10 Review Article

Loss to follow-up from antiretroviral therapy clinics:

A systematic review and meta-analysis of published

studies in South Africa from 2011 to 2015

Authors: Background: South Africa has the largest antiretroviral therapy (ART) programme in the
Samantha Kaplan 1 world. To optimise programme outcomes, it is critical that patients are retained in care and that
Katleho S. Nteso
2,3
Nathan Ford 4 retention is accurately measured.
Andrew Boulle Objectives: To identify all studies published in South Africa from 2011 to 2015 that used loss
4
Graeme Meintjes 5
to follow-up (LTFU) as an indicator or outcome to describe the variation in definitions and to
Affiliations: estimate the proportion of patients lost to care across studies.
1 Department of Internal
Medicine, University of Method: All studies published between 01 January 2011 and October 2015 that included loss
Washington, Seattle, to follow-up or default from ART care in a South African cohort were included by use of a
United States broad search strategy across multiple databases. To be included, the cohort had to include any
patient ART data, including follow-up time, from 01 January 2010. Two authors, working
2 Medical Care Development
International, Maseru, independently, extracted data and assessed risk of bias from all manuscripts. Meta-analysis
Lesotho, South Africa was performed for studies stratified by the same loss to follow-up definition.

3 School of Public Health and Results: Forty-eight adult, 15 paediatric and 4 pregnant cohorts were included. Median
Family Medicine, University cohort size was 3737; follow-up time ranged from 9 weeks to 5 years. Meta-analysis did not
of Cape Town, Cape Town, reveal an important difference in LTFU estimates in adult cohorts at 1 year between loss to
South Africa follow-up defined as 3 months (11.0%, n = 4; 95% CI 10.7% – 11.2%) compared with 6 months
(12.0%, n = 4; 95% CI 11.8% – 12.2%). Only two cohorts reported reliable LTFU estimates at
4 Centre for Infectious Disease
Epidemiology and Research, 5 years: this was 25.1% (95% CI 24.8% – 25.4%).
School of Public Health and
Family Medicine, University Conclusion: South Africa should standardise a LTFU definition. This would aid in monitoring
of Cape Town, Cape Town, and evaluation of ART programmes, with the broader goal of improving patient outcomes.
South Africa
Keywords: HIV; antiretroviral therapy (ART); loss to follow-up; disengagement; South Africa.
5 Institute of Infectious
Disease and Molecular
Medicine, Faculty of Health Introduction
Sciences, University of
Cape Town, Cape Town, As of 2016, over 7 million people in South Africa were living with human immunodeficiency virus
South Africa (HIV), of which 56% were receiving antiretroviral therapy (ART). This represents the largest ART
programme in the world : South Africa’s ART population accounts for 20% of people on ART
1
Corresponding author:
Samantha Kaplan, globally, and the country instituted updated national guidelines in 2016 to offer ART to all patients
[email protected] with HIV. Because of this rapid upscaling and increasing number of patients eligible for and
starting lifelong ART, a focus on retention in ART care has become even more important. According
Dates: to a review in South Africa from 2008 to 2013, only ± 67% of patients who initiated ART remained
Received: 22 May 2019
Accepted: 20 Aug. 2019 in care after 4 years, and 40% of those who were lost were attributed to known deaths. 2
Published: 18 Dec. 2019
Since the first availability of HIV treatment, studies have reported findings on retention after ART
initiation, usually as an indicator of programme effectiveness. There has not been a definitive
temporal trend: some studies have concluded that loss to follow-up (LTFU) proportions are
decreasing over time, but others concluded that rates have increased as the epidemic has grown,
coinciding with the increase in numbers of patients enrolled at health centres that serve ART
patients. 3,4,5,6 More recent studies have supported the notion that with increasing CD4 thresholds
for ART initiation and the adoption of ‘test and treat’, LTFU rates are increasing. 7,8,9 However,
a large part of the variation in reported outcomes is because of the lack of standardisation of
Read online:
Read online:
Scan this QR
Scan this QR How to cite this article: Kaplan S, Nteso KS, Ford N, Boulle A, Meintjes G. Loss to follow-up from antiretroviral therapy clinics: A systematic
review and meta-analysis of published studies in South Africa from 2011 to 2015. S Afr J HIV Med. 2019;20(1), a984. https://doi.
code with your org/10.4102/sajhivmed.v20i1.984
code with your
smart phone or
smart phone or
mobile device
mobile device Copyright: © 2019. The Authors. Licensee: AOSIS. This work is licensed under the Creative Commons Attribution License.
to read online.
to read online. Note: Additional supporting information may be found in the online version of this article as Online Appendix 1: https://doi.org/10.4102/
sajhivmed.v20i1.984-1 and Online Appendix 2: https://doi.org/10.4102/sajhivmed.v20i1.984-2
http://www.sajhivmed.org.za 49 Open Access