The majority of the pre-antiretroviral population who were lost to follow-up stopped their care in Freetown, Sierra Leone: a 12-month prospective cohort study starting with HIV diagnosis

Background: The heterogeneity of the pre-antiretroviral (pre-ART) population calls for more granular depictions of the cascade of HIV care.

Methods: We studied a prospective cohort of persons newly diagnosed with HIV infection from a single center in Freetown, Sierra Leone, over a 12-month period and then traced those persons who were lost to follow-up (LTFU) during pre-ART care (before ART initiation). ART eligibility was based on a CD4 cell count result of < 350 mm/cells and/or WHO clinical stage 3 or 4. Persons who attended an appointment in the final three months were considered to be retained in care. Adherence to ART was measured using pharmacy refill dates. \"Effective HIV care\" was defined as completion of the cascade of care at 12-months regardless of whether patients are on ART. Tracing outcomes were obtained for those who were LTFU during pre-ART care.

Results: 408 persons newly diagnosed with HIV infection were screened, 338 were enrolled, and 255 persons were sta...