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Lost to follow-up: failure to engage children in care in the first three months of diagnosis.

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Title: Lost to follow-up: failure to engage children in care in the first three months of diagnosis.
Authors: Machine, Edwin Masese (AUTHOR), Gillespie, Susan L. (AUTHOR), Homedes, Nuria (AUTHOR), Selwyn, Beatrice J. (AUTHOR), Ross, Michael W. (AUTHOR), Anabwani, Gabriel (AUTHOR), Schutze, Gordon (AUTHOR), Kline, Mark W. (AUTHOR)
Source: AIDS Care. Nov2016, Vol. 28 Issue 11, p1402-1410. 9p. 5 Charts.
Subjects: HIV infections & psychology, Therapeutics, Age distribution, Caregivers, HIV infections, HIV-positive persons, Immunosuppression, Interviewing, Research methodology, Evaluation of medical care, Patient compliance, Pediatrics, Probability theory, Research funding, T-test (Statistics), Socioeconomic factors, Severity of illness index, Case-control method, Data analysis software, Anti-HIV agents, Descriptive statistics, CD4 lymphocyte count, Children
Geographic Terms: Botswana
Abstract: Loss to follow-up (LTFU) is a critical factor in determining clinical outcomes in HIV treatment programs. Identifying modifiable factors of LTFU is fundamental for designing effective patient-retention interventions. We analyzed factors contributing to children LTFU from a treatment program to identify those that can be modified. A case-control study involving 313 children was used to compare the sociodemographic and clinical characteristics of children LTFU (cases) with those remaining in care (controls) at a large pediatric HIV care setting in Botswana. We traced children through caregiver contacts and those we found, we conducted structured interviews with patients’ caregivers. Children <5 years were nearly twice as likely as older children to be LTFU (57·8% versus 30·9%,p <0 .01). Approximately half (47·6%,n = 51) of LTFU patients failed to further engage in care after just one clinic visit, as compared to less than 1% (n = 2) in the control group (p < 0.01). Children LTFU were more likely than controls to have advanced disease, greater immunosuppression, and not to be receiving antiretroviral therapy. Among interviewed patient caregivers, psychosocial factors (e.g., stigma, religious beliefs, child rebellion, disclosure of HIV status) were characteristics of patients LTFU, but not of controls. Socioeconomic factors (e.g., lack of transportation, school-related activities, forgetting appointments) were cited predominantly by the controls. Pediatric patients and their caregivers need to be targeted and engaged at their initial clinic visit, with special attention to children <5 years. Possible interventions include providing psychosocial support for issues that deter patients from engaging with The Clinic. Collaboration with community-based organizations focused on reducing stigma may be useful in addressing these complex issues. [ABSTRACT FROM AUTHOR]
Copyright of AIDS Care is the property of Taylor & Francis Ltd and its content may not be copied or emailed to multiple sites without the copyright holder's express written permission. Additionally, content may not be used with any artificial intelligence tools or machine learning technologies. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)
Database: Psychology and Behavioral Sciences Collection
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  Data: Lost to follow-up: failure to engage children in care in the first three months of diagnosis.
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  Data: &lt;searchLink fieldCode=&quot;JN&quot; term=&quot;%22AIDS+Care%22&quot;&gt;AIDS Care&lt;/searchLink&gt;. Nov2016, Vol. 28 Issue 11, p1402-1410. 9p. 5 Charts.
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  Data: Loss to follow-up (LTFU) is a critical factor in determining clinical outcomes in HIV treatment programs. Identifying modifiable factors of LTFU is fundamental for designing effective patient-retention interventions. We analyzed factors contributing to children LTFU from a treatment program to identify those that can be modified. A case-control study involving 313 children was used to compare the sociodemographic and clinical characteristics of children LTFU (cases) with those remaining in care (controls) at a large pediatric HIV care setting in Botswana. We traced children through caregiver contacts and those we found, we conducted structured interviews with patients’ caregivers. Children &lt;5 years were nearly twice as likely as older children to be LTFU (57&#183;8% versus 30&#183;9%,p &lt;0 .01). Approximately half (47&#183;6%,n = 51) of LTFU patients failed to further engage in care after just one clinic visit, as compared to less than 1% (n = 2) in the control group (p &lt; 0.01). Children LTFU were more likely than controls to have advanced disease, greater immunosuppression, and not to be receiving antiretroviral therapy. Among interviewed patient caregivers, psychosocial factors (e.g., stigma, religious beliefs, child rebellion, disclosure of HIV status) were characteristics of patients LTFU, but not of controls. Socioeconomic factors (e.g., lack of transportation, school-related activities, forgetting appointments) were cited predominantly by the controls. Pediatric patients and their caregivers need to be targeted and engaged at their initial clinic visit, with special attention to children &lt;5 years. Possible interventions include providing psychosocial support for issues that deter patients from engaging with The Clinic. Collaboration with community-based organizations focused on reducing stigma may be useful in addressing these complex issues. [ABSTRACT FROM AUTHOR]
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  Data: &lt;i&gt;Copyright of AIDS Care is the property of Taylor &amp; Francis Ltd and its content may not be copied or emailed to multiple sites without the copyright holder&#39;s express written permission. Additionally, content may not be used with any artificial intelligence tools or machine learning technologies. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract.&lt;/i&gt; (Copyright applies to all Abstracts.)
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        Value: 10.1080/09540121.2016.1179714
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        Type: general
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      – SubjectFull: Age distribution
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      – SubjectFull: Patient compliance
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      – SubjectFull: Pediatrics
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      – TitleFull: Lost to follow-up: failure to engage children in care in the first three months of diagnosis.
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