HIGH LOSS TO FOLLOW UP AMONG CHILDREN ON PRE-ART CARE UNDER NATIONAL AIDS PROGRAM IN MADURAI, SOUTH INDIA.

BACKGROUND Information on the follow-up of HIV-infected children enrolled into pre-antiretroviral therapy (Pre-ART) care under routine program settings is limited in India. Knowledge on the magnitude of loss to follow up (LFU) and its reasons will help programs to retain children in HIV care. We aimed to assess the proportion of LFU among children in Pre-ART care and its associated factors. METHODS In this retrospective cohort study, we reviewed the records of all HIV-infected children (aged <15 years) registered from 2005 to 2012 at an ART centre, Madurai, South India. LFU during pre-ART care was defined as having not visited the ART centre within a year of registration. RESULTS Of 426 children enrolled in Pre-ART care, 211 (49%) were females and 301 (71%) were in the 5-14 years age group. At one year of registration, 348 (82%) were lost to follow-up. Of 348, 81 returned to care after one year of enrolment while 267 (63% of all children) were permanently lost-to-follow-up. The proportion of LFU remained high from 2005 to 2012. WHO staging, CD4 count and OI were the significant factors associated with lost to follow-up on multivariate analysis. CONCLUSION LFU was alarmingly high indicating poor clinical and programmatic monitoring among HIV-infected children enrolled in pre-ART care. A system for active tracing of those missing a clinic appointment, intensified supervision and monitoring along with qualitative research is urgently needed. This will help to understand the exact reasons for LFU based on which effective interventions may be planned for reducing such losses.