# Incidence and predictors of loss to follow-up among South Sudanese refugees with HIV receiving care in Adjumani District, Uganda

## TL;DR

The study finds a 6% loss to follow-up rate among South Sudanese refugees with HIV in Uganda, with men and certain health centers at higher risk.

## Contribution

The study identifies specific predictors of loss to follow-up in a refugee population with HIV, offering targeted strategies to improve care retention.

## Key findings

- Loss to follow-up rate was 5.6% among South Sudanese refugees with HIV in Adjumani District.
- Being male and receiving care at health center IV were independently associated with higher LTFU risk.

## Abstract

•There is about a 6% loss to follow-up rate (LTFU) in South Sudanese refugees with HIV.•Men and health center IV patients had higher LTFU risk.•Targeted outreach and better HIV care may reduce LTFU.•Findings inform refugee HIV care retention strategies.

There is about a 6% loss to follow-up rate (LTFU) in South Sudanese refugees with HIV.

Men and health center IV patients had higher LTFU risk.

Targeted outreach and better HIV care may reduce LTFU.

Findings inform refugee HIV care retention strategies.

HIV care pose a significant challenge in refugee population. We determined the incidence and predictors of loss to follow-up (LTFU) among South Sudanese refugees with HIV in Uganda.

We conducted a retrospective cohort study in public health facilities in Adjumani District, Uganda, involving South Sudanese refugees with HIV. LTFU was defined as missing 3 or more consecutive months at any point in their care since the start of the study period. A Cox proportional hazards regression analysis was fitted to determine independent predictors of LTFU and results are presented as adjusted hazard ratios (aHRs) with corresponding 95% confidence intervals (CIs).

We included data of 449 participants, with a median age of 37 (interquartile range: 30-43) years. Most were female patients (75.5%, n = 339) receiving care from health center (HC) III (87.3%, n = 392), with baseline World Health Organization stage 1 (79.3%, n = 341), negative baseline tuberculosis status (89.1%, n = 302), and suppressed viral load (86.5%, n = 360) and had no co-morbidity (91%, n = 402). Overall, 25 (5.6%) were lost to follow-up. Factors independently associated with LTFU were being male (aHR: 2.6, 95% CI: 1.1-6.1, P = 0.03) and receiving care from HC IV (aHR: 3.0, 95% CI: 1.0-8.8, P = 0.04).

LTFU among South Sudanese refugees with HIV in Uganda is substantial. Routine use of patient address locator forms, and improved quality of HIV care at HC IV and men-targeted outreaches and community involvement may reduce LTFU among refugees living with HIV.