par Dunbar, Willy ;Sohler, Nancy;Coppieters, Yves
Référence European journal of public health, 30, Supplement_5
Publication Publié, 2020-09-01
Article révisé par les pairs
Résumé : Abstract Background Despite the benefits of adherence in HIV medication, health systems are struggling to keep all categories of patients in care due to loss to follow up (LTFU). Men who have sex with men (MSM) are at higher risk of HIV infection and also face several barriers to reach treatment, it is hypothesized that they may also have higher incidence of dropping-off. This study aims to determine whether MSM living with HIV have a greater risk of LTFU compared with heterosexual men and to identify the risk factors for the two groups. Methods A retrospective matched cohort study of electronic medical record data from 554 patients living with HIV and enrolled in care between 2015 and 2018 at a Port-au-Prince-based HIV clinic was performed. The 125 MSM and 429 heterosexual patients were matched on gender age and enrolment date. The primary outcome was LTFU defined as not refilling an ART prescription for a period of 90 days. MSM and heterosexual men was compared using t-tests and chi-square tests. The Kaplan-Meier technique was used to estimate time to LTFU after initiation of ART and the Cox Proportional Hazards regression model was used to determine predictors of LTFU. Results The sample had a mean age of 31.1 years (SD 8.0) for MSM and 32.4 years (SD 7.7) for heterosexual men. LTFU was significantly more common among the MSM group than the heterosexual group (MSM 48.8%, heterosexual men 34.7%; p = 0.012). Factors associated with LTFU were greater amongst younger patients, with lower educational and economic level. The median time to LTFU for MSM was 679 days and 1110 days for heterosexual men. The log rank test showed that this is statistically significant at p = 0.001. Conclusions This study showed that the risk of LTFU is significantly higher and the time to LTFU is significantly shorter for MSM relative to heterosexual men. Identifying predictors to LTFU in HIV clinical settings and providing appropriate services and supports are important steps in addressing this issue. Key messages Men who have sex with men continue to face barriers to effective HIV treatment in Haiti. Adapted interventions are needed to improve HIV care for Men who have sex with Men in Haiti.