Who is lost to follow‐up in HIV care? Assessment of care retention over time and the impact of COVID‐19. Longitudinal analysis of the PISCIS cohort

Abstract

AbstractIntroductionPeople living with HIV who are lost to follow‐up have a greater risk of health deterioration, mortality, and community transmission.ObjectiveOur aim was to analyse both how rates of loss to follow‐up (LTFU) changed between 2006 and 2020 and how the COVID‐19 pandemic affected these rates in the PISCIS cohort study of Catalonia and the Balearic Islands.MethodsWe analysed socio‐demographic and clinical characteristics of LTFU yearly and with adjusted odds ratios to assess the impact of these determinants on LTFU in 2020 (the year of COVID‐19). We used latent class analysis to categorize classes of LTFU based on their socio‐demographic and clinical characteristics at each year.ResultsIn total, 16.7% of the cohort were lost to follow‐up at any time in the 15 years (n = 19 417). Of people living with HIV who were receiving follow‐up, 81.5% were male and 19.5% were female; of those who were lost to follow‐up, 79.6% and 20.4% were male and female, respectively (p < 0.001). Although rates of LTFU increased during COVID‐19 (1.11% vs. 0.86%, p = 0.024), socio‐demographic and clinical factors were similar. Eight classes of people living with HIV who were lost to follow‐up were identified: six for men and two for women. Classes of men (n = 3) differed in terms of their country of birth, viral load (VL), and antiretroviral therapy (ART); classes of people who inject drugs (n = 2) differed in terms of VL, AIDS diagnosis, and ART. Changes in rates of LTFU included higher CD4 cell count and undetectable VL.ConclusionsThe socio‐demographic and clinical characteristics of people living with HIV changed over time. Although the circumstances of the COVID‐19 pandemic increased the rates of LTFU, the characteristics of these people were similar. Epidemiological trends among people who were lost to follow‐up can be used to prevent new losses of care and to reduce barriers to achieve Joint United Nations Programme on HIV/AIDS 95‐95‐95 targets.