Table 1.

Characteristics of reports, cohorts, and patients included in this review of attrition rates from ART Programs in sub-Saharan Africa

Study Code	Reference	Country	Eligibility criteria (; = ‘or’)*	LTFU definition	Facilities (n)	Sector	Payment by patient required?	Dates of cohort observation	Cohort size (n)	Median age (years)	Female (%)	Median starting CD4 count (Cells/mm3)
Botswana 1 (Bisson et al. 2008)	Bisson 2008	Botswana	CD4 < 200; OI	30 days late for last scheduled appt	1	Public	No	Feb 2003 – Mar 2004	410	37†	60	81
Botswana 2 (Bussmann et al. 2008)	Bussman 2008	Botswana	CD4 < 200; ADOI	Not reported	1	Public	No	Jan 2002 – Apr 2007	633	35	60	67
Cameroon 1 (Sieleunou et al. 2009)	Sieleunou 2009	Cameroon‡	CD4 < 200; WHO 3 or 4	>3 months late for last visit	1	NGO	Partial	Jul 2001 – Jun 2007	1,187	35	44	105
Congo 1 (O’Brien et al. 2009)	O’Brien 2009	Congo§	‘WHO recommendations’ (cites 2006 WHO guidelines)	Not reported	2	NGO	No	Mar 2005 – Dec 2007	222	37	69	104
Cote d’Ivoire1 (Toure et al. 2008)	Toure 2008	Cote d’Ivoire	CD4 < 200; WHO 4; WHO 3 + CD4 200–350	>3 months since last contact with clinic	Multiple	NGO	Partial	May 2004 – Feb 2007	10,211	36	70	123
DRC 1 (Culbert et al. 2007)	Culbert 2007	DRC Congo	‘WHO guidelines’ (cites 2003 guidelines)	Not reported	2	NGO	No	Oct 2003 – Jan 2006¶	494	37	66	123
Ethiopia 1 (Gugsa 2008)	Gugsa 2008	Ethiopia	Not reported	Not reported	1	Public	–	Sep 2005 – Sep 2006¶	321	–	59	102**
Ghana 1 (Chiliade 2008)	Chiliade 2008	Ghana	Not reported	Not reported	Multiple	NGO	–	–	5,844	–	63	114
Ghana 2 (Collini et al. 2009)	Collini 2009	Ghana‡	CD4 < 250; WHO 3 or 4	Not reported	1	Public	Partial	Jan 2004 –	237	40 †	59	120†
Kenya 1 (Unge et al. 2009)	Unge 2009	Kenya‡	WHO stage (not specified)	> 90 days after last prescribed dose	1	NGO	Free	Jan 2005 – Sep 2007¶	830	35	65	203
Malawi 1 (Jahn 2008)	Jahn 2008	Malawi††	Not reported	Not reported	146	Public	–	Jun 2004 – Jul 2007¶	114,375	–	61	–
Mozambique 1 (Auld 2009)	Auld 2009	Mozambique‡‡	Not reported	Not reported	30	Public	–	2004 – 2007¶	2,596	34	62	–
Multiple 1 (Marazzi et al. 2008)	Marazzi 2008	Mozambique, Tanzania, Malawi	CD4 < 200 + WHO 3 or 4; CD4 200–350 + viral load >55,000	Not reported	12	NGO	–	Jan 2003 – Jun 2006	3,456	37	60	166†
Multiple 2 (Palombi et al. 2009)	Palombi 2009	Mozambique, Malawi, Guinea‡	Not reported	>3 months since last contact	5	NGO	–	–Jun 2007	3,749	34	62	192
Nigeria 1 (DeSilva et al. 2009)	DeSilva 2009	Nigeria	Not reported	No visit for > 3 months before data collection	1	NGO	–	Jan 2005 – Dec 2006	1,552	34	71	112
Rwanda 1 (Chiliade 2008)	Chiliade 2008	Rwanda	Not reported	Not reported	Multiple	NGO	–	–	1,707	–	64	150
Rwanda 2 (Lowrance et al. 2009)	Lowrance 2009	Rwanda‡‡	WHO 4; WHO 3 + CD4 < 350; WHO 1 or 2 + CD4 < 200	>90 days since last contact	30	Public	–	Jan 2004 – Dec 2005	3,194	37	65	141
SA 1 (Boulle et al. 2008)	Boulle 2008	South Africa	WHO 4 excluding EPTB; CD4 < 200	>90 days since last contact	Multiple	Public	–	May 2001 – Mar 2006	12,587	–	70	–
SA 2 (Barth et al. 2009)	Barth 2008	South Africa	Not reported	Not reported	1	NGO	–	–	735	34	72	68
SA 3 (Dahab 2008)	Dahab 2008	South Africa	Not reported	>1 month late for six–month visit	1	Public	No	–	267	37	67	–
SA 4a (Grimwood A 2008)	Grimwood 2008	South Africa	Not reported	Not reported	–	Public	No	Jan 2003 – Dec 2007¶	6,469	–	–	117
SA 4b (Grimwood A 2008)	Grimwood 2008	South Africa	Not reported	Not reported	–	Public	No	Jan 2003 – Dec 2007¶	1,135	–	–	127
SA 5 (Khan 2009)	Khan 2009	South Africa§§	Not reported	‘Failure to collect ARV’	1	Public	–	Jul 2004 – Jun 2005¶	684	–	73	–
SA 6 (Kaplan et al. 2008)	Kaplan 2008	South Africa¶¶	Not reported	No clinic visit > 12 weeks	1	Public	No	Sep 2002 – Sep 2007¶	1,677	–	100	–
SA 7 (MacPherson et al. 2009)	MacPherson 2009	South Africa	CD4 < 200 + WHO 4 + ‘psychosocial preparedness to undertake therapy’	>1 day late for appointment, could not be traced, and did not come back during study period	1	Public	No	Oct 2005 – Sept 2007¶	1,353	37	67	93
SA 8 (Nachega et al. 2008)	Nachega 2008	South Africa***	Two CD4s<350; confirmed ADOI	Leaving medical insurance fund or AID for AIDS program	Multiple	Private	Yes	Jan 1998 – Sep 2004¶	2,817	37†	63	147
SA 9 (Ojikutu et al. 2008)	Ojikutu 2008	South Africa†††	CD4 < 200; WHO 4	No clinic visit within 6 months of end of study	1	NGO	Yes	Jan 1999 – Feb 2004¶	309	38†	56	65
SA 10a (Rosen et al. 2008)	Rosen 2008	South Africa	CD4 < 200	>3 months late for last visit	1	Public	Partial	Jan 2005 – Dec 2006	100	–	–	97‡‡‡
SA 10b (Rosen et al. 2008)	Rosen 2008	South Africa	CD4 < 200	>3 months late for last visit	1	Private	No	Jan 2005 – Dec 2006	100	–	–	84‡‡‡
SA 10c (Rosen et al. 2008)	Rosen 2008	South Africa	CD4 < 200	>3 months late for last visit	1	NGO	Partial	Jan 2005 – Dec 2006	100	–	–	60‡‡‡
SA 10d (Rosen et al. 2008)	Rosen 2008	South Africa	CD4 < 200	>3 months late for last visit	1	NGO	Partial	Jan 2005 – Dec 2006	100	–	–	104‡‡‡
Tanzania 1 (Chalamilla 2008)	Chalamilla 2008	Tanzania	Not reported	Not reported	–	–	–	Nov 2004 – Apr 2007¶	6,893	37	71	133
Tanzania 2 (Johannessen et al. 2008)	Johannessen 2008	Tanzania	CD4 < 200; WHO 4; WHO 3 + CD4 200–350	>3 months late for last appt and could not be traced	1	NGO	No	Oct 2003 – May 2007	320	35	70	–
Uganda 1a (Ahoua et al. 2009)	Ahoua 2009	Uganda	WHO guidelines (cites 2003 guidelines)	>2 months late for last appt	1	Public	No	Sept 2004 – May 2006	967	37	65	100
Uganda 1b (Ahoua et al. 2009)	Ahoua 2009	Uganda	WHO guidelines (cites 2003 guidelines)	>2 months late for last appt	1	Public	No	Sept 2003 – May 2006	556	37	62	93
Uganda 2 (Chang et al. 2009)	Chang 2009	Uganda	CD4 < 250; WHO 3 or 4	>90 days since last visit and on ART	1	NGO	No	Oct 2003 – Apr 2006	360	38§§§	66§§§	100§§§
Uganda 3 (Bajunirwe et al. 2007)	Bajunirwe 2007	Uganda	Not reported	Not reported	1	Public	–	Dec 2004 – Dec 2006¶	398	–	–	–
Uganda 4 (Martin 2008)	Martin 2008	Uganda	Not reported	‘Where abouts unknown for 6 months or more’	1	–	No	–	323	35	71	124
Zambia 1 (Chi et al. 2009)	Chi 2009	Zambia	CD4 < 200; WHO 4; WHO 3 + CD4 200–350	>30 days late for last medication pickup and can not be traced	18	Public	No	Apr 2004 – Nov 2008	37,039	35¶¶¶	61¶¶¶	126¶¶¶
Total or weighted average									226,307****	36††††	63††††	128††††

“—” indicates information not reported in study.

NGO, nongovernmental organization, ADOI, AIDS defining opportunistic infection, EPTB, extra-pulmonary tuberculosis.

^*Many public sector ART programs that did not report eligibility criteria likely followed national guidelines, which are typically consistent with WHO recommendations.

^†Median not reported, mean reported instead.

^‡Required at least one follow-up visit.

^§Includes non-naïve patients.

^¶Period during which study participants initiated ART; follow-up extends beyond dates shown.

^**Weighted the medians for those lost, died or retained by sample size.

^††Sampled entire national program (adults).

^‡‡Representative sample of the national program.

^§§Includes 75 children.

^¶¶Rate from KM estimates only. Weighted average of pregnant and non-pregnant subjects.

^***Study compared EFV and NVP; rates shown are for combined cohort.

^†††Includes non-naïve patients. Patients with missing records excluded.

^‡‡‡Weighted average of outcome groups.

^§§§Weighted averages of those on treatment and those not on treatment.

^¶¶¶Weighted averages of those on treatment at 12 months and those not.

^****Total.

^††††Weighted by sample size.