Identifying risk factors for loss to follow-up in adults living with HIV in a high-burden district in Ghana.

Background: Loss to follow-up (LTFU) in the care of persons living with HIV hinders the effectiveness of treatment strategies and undermines global health initiatives to achieve targets such as the 95-95-95 goals. Identifying risk factors for LTFU will help develop effective interventions that enhance long-term outcomes for people living with HIV (PLWHIV). Thus, this study aimed to explore the risk factors influencing LTFU among PLWHIV in a high-burden district in Ghana.

Methods: A retrospective analysis was conducted using medical records of 401 patients who initiated Antiretroviral Therapy (ART) between January 1st, 2011, and December 31st, 2021, in a high-burden district in Ghana and data extraction period of January to December 2022. We defined LTFU as a failure of a patient to return to the HIV clinic for at least 30, 90, 180, and 270 days from the date of their last appointment. A logistic regression model was utilized to determine the risk factors associated with LTFU.

Results: Out of 401 records reviewed, 298 (74%) were females. The proportions of individuals LTFU were 46%, 26%, and 15% for 90 days, 180 days, and 270 days, respectively. Additionally, only 14% of patients achieved the required four or more hospital visits within the last year of the review. Education was a risk factor associated with LTFU, with individuals with primary education (aOR = 0.32, 95% CI: 0.15, 0.66) and senior high school or higher education (aOR = 0.51, 95% CI: 0.27, 0.99) having lower odds of LTFU compared to those with no education. The duration of HIV care was also associated with LTFU. Patients who were in care for less than or equal to five years were more likely to be LTFU compared to those in care for more than five years. None of the clinical variables were associated with loss to follow-up.

Conclusion: Our study provides new information about LTFU and its associated risk factors in Ghana. These findings underscore the need to promote health literacy in the fight against HIV/AIDS in Ghana.