Determinants of loss to follow-up among people living with HIV receiving antiretroviral therapy in a universal test and treat setting: A retrospective cohort study in Nepal
Objectives: This study aims to assess the cumulative incidence and rate of loss to follow-up (LTFU) among people living with HIV (PLHIV) in Nepal who begin antiretroviral therapy (ART) early, as well as to identify factors associated with LTFU in the context of the universal test and treat approach....
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Elsevier
2025-12-01
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| Series: | Public Health in Practice |
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S2666535225000539 |
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| author | Archana Shrestha Lisasha Poudel Bikram Adhikari Saroj Bhandari Roman Shrestha Rajya Shree Kunwar Lok Raj Pandey Man Bahadur KC Erin C. Wilson Keshab Deuba |
| author_facet | Archana Shrestha Lisasha Poudel Bikram Adhikari Saroj Bhandari Roman Shrestha Rajya Shree Kunwar Lok Raj Pandey Man Bahadur KC Erin C. Wilson Keshab Deuba |
| author_sort | Archana Shrestha |
| collection | DOAJ |
| description | Objectives: This study aims to assess the cumulative incidence and rate of loss to follow-up (LTFU) among people living with HIV (PLHIV) in Nepal who begin antiretroviral therapy (ART) early, as well as to identify factors associated with LTFU in the context of the universal test and treat approach. Study design: Retrospective cohort study. Methods: We retrospectively analysed nationally representative routine programme data for all PLHIV initiated on ART from February 19, 2017, to February 18, 2020, and followed up until May 10, 2022. LTFU was defined as a client not returning to the HIV clinic for at least 3 months from the date of their last scheduled appointment. We calculated cumulative incidence rate (IR) and used a multivariable Cox proportional hazards regression model to identify factors associated with LTFU, reporting corresponding 95% confidence intervals (CI). Results: Of the 8192 clients included in our sample, 6797 (82.9 %) started ART within seven days following their HIV diagnosis. The overall IR of LTFU was 4.22 (95 % CI = 3.95–4.51) per 100 person years of observation. The cumulative incidence of LTFU increased over time on ART, from 3.81 % (95 % CI = 3.40–4.26) at 6 months, 6.51 % (95 % CI = 5.97–7.09) at 12 months to 13.41 % (95 % CI = 12.51–14.37) at 48 months. In the multivariable model, factors associated with higher odds of LTFU included initiating treatment within 7 days of diagnosis, younger age, being unmarried, belonging to the Dalit caste, having WHO clinical stage 1 at baseline, and initiation on a non-nucleoside reverse transcriptase inhibitors (NNRTI)-based regimen. Among key populations, sex workers, their clients, men who have sex with men and transgender, people who inject drugs were at higher risk of dropout compared to migrants. Conclusions: In this nationwide cohort, the risk of LTFU increased with time on ART. To optimize the test-and-treat strategy in Nepal, it is crucial to address the unique needs of youth and certain key populations and manage any early adverse drug reactions. |
| format | Article |
| id | doaj-art-5ec09ca5fcd4418d9899eea76b149cbf |
| institution | OA Journals |
| issn | 2666-5352 |
| language | English |
| publishDate | 2025-12-01 |
| publisher | Elsevier |
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| series | Public Health in Practice |
| spelling | doaj-art-5ec09ca5fcd4418d9899eea76b149cbf2025-08-20T02:36:19ZengElsevierPublic Health in Practice2666-53522025-12-011010063410.1016/j.puhip.2025.100634Determinants of loss to follow-up among people living with HIV receiving antiretroviral therapy in a universal test and treat setting: A retrospective cohort study in NepalArchana Shrestha0Lisasha Poudel1Bikram Adhikari2Saroj Bhandari3Roman Shrestha4Rajya Shree Kunwar5Lok Raj Pandey6Man Bahadur KC7Erin C. Wilson8Keshab Deuba9Department of Public Health and Community Programs, Kathmandu University School of Medical Sciences, Dhulikhel, Nepal; Center for Methods in Implementation and Prevention Science, Yale School of Public Health, New Haven, CT, USA; Institute for Implementation Science and Health, Kathmandu, NepalInstitute for Implementation Science and Health, Kathmandu, NepalDepartment of Public Health and Community Programs, Kathmandu University School of Medical Sciences, Dhulikhel, NepalSave the Children International, Kathmandu, NepalDepartment of Allied Health Sciences, University of Connecticut, Storrs, USASave the Children International, Kathmandu, NepalNational Centre for AIDS & STD Control, Ministry of Health and Population, Kathmandu, NepalNational Centre for AIDS & STD Control, Ministry of Health and Population, Kathmandu, NepalSan Francisco Department of Public Health, San Francisco, CA, USAPublic Health and Environment Research Centre (PERC), Lalitpur, Nepal; Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden; Centre for International Health (CIH), Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway; Corresponding author. Department of Global Public Health, Karolinska Institutet, 17177, Stockholm, Sweden.Objectives: This study aims to assess the cumulative incidence and rate of loss to follow-up (LTFU) among people living with HIV (PLHIV) in Nepal who begin antiretroviral therapy (ART) early, as well as to identify factors associated with LTFU in the context of the universal test and treat approach. Study design: Retrospective cohort study. Methods: We retrospectively analysed nationally representative routine programme data for all PLHIV initiated on ART from February 19, 2017, to February 18, 2020, and followed up until May 10, 2022. LTFU was defined as a client not returning to the HIV clinic for at least 3 months from the date of their last scheduled appointment. We calculated cumulative incidence rate (IR) and used a multivariable Cox proportional hazards regression model to identify factors associated with LTFU, reporting corresponding 95% confidence intervals (CI). Results: Of the 8192 clients included in our sample, 6797 (82.9 %) started ART within seven days following their HIV diagnosis. The overall IR of LTFU was 4.22 (95 % CI = 3.95–4.51) per 100 person years of observation. The cumulative incidence of LTFU increased over time on ART, from 3.81 % (95 % CI = 3.40–4.26) at 6 months, 6.51 % (95 % CI = 5.97–7.09) at 12 months to 13.41 % (95 % CI = 12.51–14.37) at 48 months. In the multivariable model, factors associated with higher odds of LTFU included initiating treatment within 7 days of diagnosis, younger age, being unmarried, belonging to the Dalit caste, having WHO clinical stage 1 at baseline, and initiation on a non-nucleoside reverse transcriptase inhibitors (NNRTI)-based regimen. Among key populations, sex workers, their clients, men who have sex with men and transgender, people who inject drugs were at higher risk of dropout compared to migrants. Conclusions: In this nationwide cohort, the risk of LTFU increased with time on ART. To optimize the test-and-treat strategy in Nepal, it is crucial to address the unique needs of youth and certain key populations and manage any early adverse drug reactions.http://www.sciencedirect.com/science/article/pii/S2666535225000539Test and treatAntiretroviral therapyPeople living with HIVNepal |
| spellingShingle | Archana Shrestha Lisasha Poudel Bikram Adhikari Saroj Bhandari Roman Shrestha Rajya Shree Kunwar Lok Raj Pandey Man Bahadur KC Erin C. Wilson Keshab Deuba Determinants of loss to follow-up among people living with HIV receiving antiretroviral therapy in a universal test and treat setting: A retrospective cohort study in Nepal Public Health in Practice Test and treat Antiretroviral therapy People living with HIV Nepal |
| title | Determinants of loss to follow-up among people living with HIV receiving antiretroviral therapy in a universal test and treat setting: A retrospective cohort study in Nepal |
| title_full | Determinants of loss to follow-up among people living with HIV receiving antiretroviral therapy in a universal test and treat setting: A retrospective cohort study in Nepal |
| title_fullStr | Determinants of loss to follow-up among people living with HIV receiving antiretroviral therapy in a universal test and treat setting: A retrospective cohort study in Nepal |
| title_full_unstemmed | Determinants of loss to follow-up among people living with HIV receiving antiretroviral therapy in a universal test and treat setting: A retrospective cohort study in Nepal |
| title_short | Determinants of loss to follow-up among people living with HIV receiving antiretroviral therapy in a universal test and treat setting: A retrospective cohort study in Nepal |
| title_sort | determinants of loss to follow up among people living with hiv receiving antiretroviral therapy in a universal test and treat setting a retrospective cohort study in nepal |
| topic | Test and treat Antiretroviral therapy People living with HIV Nepal |
| url | http://www.sciencedirect.com/science/article/pii/S2666535225000539 |
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