{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,25]],"date-time":"2026-10-25T16:27:21Z","timestamp":1792945641140,"version":"4.5.0"},"reference-count":44,"publisher":"BMJ","issue":"7","license":[{"start":{"date-parts":[[2026,7,24]],"date-time":"2026-07-24T00:00:00Z","timestamp":1784851200000},"content-version":"unspecified","delay-in-days":23,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2026,6,17]]},"published-print":{"date-parts":[[2026,7]]},"abstract":"<jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>This study aimed to estimate the incidence and predictors of loss to follow-up (LTFU) among adults after antiretroviral therapy (ART) initiation at five provincial referral hospitals in Sierra Leone.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design<\/jats:title>\n                    <jats:p>A facility-based retrospective cohort study.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Setting<\/jats:title>\n                    <jats:p>This study was conducted at five provincial government referral hospitals in Sierra Leone from January 2020 to December 2024.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Participant<\/jats:title>\n                    <jats:p>HIV patients aged 15 and above who initiated ART between 1 January 2020, and 31 December 2020, and attended at least one follow-up visit at the five national referral hospitals.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Primary outcome measure<\/jats:title>\n                    <jats:p>The primary outcome in this study was LTFU. LTFU was defined as absence from care, operationalised as no documented clinical encounter and\/or ART refill for \u226590 days after the last expected clinical contact among patients not recorded as dead or transferred out.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Of the 1544\u2009patients (67.7% female), the median follow-up was 4.25 years (IQR not stated), totalling 5748.6 PY. Outcomes were 550 LTFU (35.6%), 853 in care (55.2%), 64 (4.1%) transferred and 77 (5.0%) died. The LTFU incidence was 9.57 per 100 PY (95%\u2009CI 8.78 to 10.37). Multivariable analyses revealed several factors significantly associated with higher LTFU: lack of tuberculosis (TB) screening (HR=4.47; 95%\u2009CI 3.66 to 5.46), WHO stage III\/IV (HR=1.51; 95%\u2009CI 1.20 to 1.89), no regimen change (HR=5.12; 95%\u2009CI 2.39 to 11.00), non-disclosure of HIV status (HR=1.63; 95%\u2009CI 1.19 to 2.25), underweight body mass index (BMI) at follow-up (HR=1.37; 95%\u2009CI 1.05 to 1.78) and residence in the Southern (HR=1.97; 95%\u2009CI 1.57 to 2.48)\u2009or Eastern region (HR=2.13; 95%\u2009CI 1.49 to 3.03). Conversely, rural residence was associated with lower LTFU (HR=0.58; 95%\u2009CI 0.43 to 0.79).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>The study found a substantial incidence of LTFU. Risk factors of LTFU were gaps in TB screening, advanced clinical stage, absence of timely regimen adjustments, non-disclosure, low BMI and regional disparities. Strengthening integrated TB\/HIV services, nutritional support, disclosure-enabling counselling and region-specific retention strategies, especially in urban, Southern and Eastern areas, may improve retention.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2026-117774","type":"journal-article","created":{"date-parts":[[2026,7,24]],"date-time":"2026-07-24T13:20:37Z","timestamp":1784899237000},"page":"e117774","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":1,"title":["Incidence and predictors of loss to follow-up after ART initiation at public health facilities in Sierra Leone (2020\u20132024): a retrospective cohort study"],"prefix":"10.1136","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6457-3121","authenticated-orcid":false,"given":"Lovel","family":"Fornah","sequence":"first","affiliation":[{"name":"Department of Epidemiology, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China"},{"name":"Department of Public Health, Faculty of Health and Allied Sciences, Ernest Bai Koroma University of Science and Technology, Makeni, Maken, Sierra Leone"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0226-841X","authenticated-orcid":false,"given":"Augustus","family":"Osborne","sequence":"additional","affiliation":[{"name":"Institute for Development (IfD), Freetown, Sierra Leone"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5633-1309","authenticated-orcid":false,"given":"Mulugeta Shegaze","family":"Shimbre","sequence":"additional","affiliation":[{"name":"Department of Epidemiology, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wei","family":"Ma","sequence":"additional","affiliation":[{"name":"Department of Epidemiology, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2026,7,24]]},"reference":[{"key":"2026090306255665000_16.7.e117774.1","unstructured":"UNAIDS, Global HIV . 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