{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,8]],"date-time":"2026-10-08T00:59:18Z","timestamp":1791421158344,"version":"4.3.3"},"reference-count":57,"publisher":"Wiley","issue":"3","license":[{"start":{"date-parts":[[2020,3,3]],"date-time":"2020-03-03T00:00:00Z","timestamp":1583193600000},"content-version":"vor","delay-in-days":2,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Ministry of Health and Social Welfare of the Government of Tanzania"},{"name":"Government of the Canton of Basel, Switzerland"},{"name":"Swiss Tropical and Public Health Institute, Basel, Switzerland"},{"name":"Ifakara Health Institute, Tanzania"},{"name":"USAID Boresha Afya"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["J Intern AIDS Soc"],"published-print":{"date-parts":[[2020,3]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Introduction<\/jats:title><jats:p>Lifelong antiretroviral therapy (ART) improves health outcomes for HIV\u2010positive individuals, but is jeopardized by irregular clinic attendance and hence poor adherence. Loss to follow\u2010up (LTFU) is typically defined retrospectively but this may lead to biased inferences. We assessed incidence of and factors associated with LTFU, prospectively and accounting for recurrent LTFU episodes, in the Kilombero and Ulanga Antiretroviral Cohort (KIULARCO) of HIV\u2010positive persons in rural Tanzania.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We included adults (\u226515\u00a0years) enrolled in 2005 to 2016, regardless of ART status, with follow\u2010up through April 2017. LTFU was defined as &gt;60\u00a0days late for a scheduled appointment. Participants could experience multiple LTFU episodes. We performed analyses based on the first (prospective) and last (retrospective) events observed during follow\u2010up, and accounting for recurrent LTFU episodes. Time to LTFU was estimated using cumulative incidence functions. We assessed factors associated with LTFU using cause\u2010specific proportional hazards, marginal means\/rates, and Prentice, Williams and Peterson models.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Among 8087 participants (65% female, 60% aged \u226535\u00a0years, 42% WHO stage 3\/4, and 47% CD4 count &lt;200\u00a0cells\/mm<jats:sup>3<\/jats:sup>), there were 8140 LTFU episodes, after which there were 2483 (31%) returns to care. One\u2010year LTFU probabilities were 0.41 (95% confidence interval 0.40, 0.42) and 0.21 (0.20, 0.22) considering the first and last events respectively. Factors associated with LTFU were broadly consistent across different models: being male, younger age, never married, living far from the clinic, not having an HIV\u2010positive partner, lower BMI, advanced WHO stage, not having tuberculosis, and shorter time since ART initiation. Associations between LTFU and pregnancy, CD4 count, and enrolment year depended on the analysis approach.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>LTFU episodes were common and prompt tracing efforts are urgently needed. We identified socio\u2010demographic and clinical characteristics associated with LTFU that can be used to target tracing efforts and to help inform the design of appropriate interventions. Incidence of and risk factors for LTFU differed based on the LTFU definition applied, highlighting the importance of appropriately accounting for recurrent LTFU episodes. We recommend using a prospective definition of LTFU combined with recurrent event analyses in cohorts where repeated interruptions in care are common.<\/jats:p><\/jats:sec>","DOI":"10.1002\/jia2.25460","type":"journal-article","created":{"date-parts":[[2020,3,4]],"date-time":"2020-03-04T05:24:55Z","timestamp":1583299495000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":27,"title":["Prospective assessment of loss to follow\u2010up: incidence and associated factors in a cohort of HIV\u2010positive adults in rural Tanzania"],"prefix":"10.1002","volume":"23","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5862-9264","authenticated-orcid":false,"given":"Aneth V","family":"Kalinjuma","sequence":"first","affiliation":[{"name":"Ifakara Health Institute Ifakara Tanzania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7075-9803","authenticated-orcid":false,"given":"Tracy 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