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J Int Assoc Provid AIDS Care. 2014 Nov-Dec;13(6):547-54. doi: 10.1177/2325957413501719. Epub 2013 Sep 30.

Inadequate monitoring in advanced stages of disease with lack of supportive counseling increases attrition among patients on antiretroviral treatment at a large urban clinic in Uganda.

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  • 1Infectious Diseases Institute, Makerere University College of Health Sciences, Kampala, Uganda
  • 2Reach Out Mbuya Parish HIV/AIDS Initiative, Kampala, Uganda.
  • 3Infectious Diseases Institute, Makerere University College of Health Sciences, Kampala, Uganda.
  • 4Department of Medicine, Makerere University College of Health Sciences, Kampala, Uganda.
  • 5Department of Epidemiology and Social Medicine, University of Antwerp, Antwerp, Belgium Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium.



The purpose of this case-control study was to identify risk factors for loss to follow-up (LTFU).


Cases and controls were selected from HIV-positive patients, aged 18 years and older, on antiretroviral therapy (ART) at the Infectious Diseases Clinic (IDC) in January 2008. As cases, we selected 209 patients who in 2008 did not return to the clinic within 90 days of their scheduled appointment date. As controls, we randomly selected 626 patients from the 5872 patients who were following up at the end of December 2008.


In multivariable logistic regression analysis, urban or semiurban residence, World Health Organization disease stage III or IV at ART initiation, a median CD4 count at last visit <200 cells/mm(3), tuberculosis (TB) in the 6 months before the last visit, absence of counseling before ART initiation, and no disclosure of HIV status were associated with LTFU.


This study demonstrates the importance of close patient monitoring in advanced stages of disease, supportive counseling for patients initiating ART, extra psychosocial support for patients with TB and HIV coinfection, assisting patients with disclosure, and setting up a good referral system to retain patients on ART.


HIV-positive patients; Uganda; advanced disease; counseling; inadequate monitoring; patient attrition

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