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Of a total of 19,774 patients enrolled in the IDI program between January 2005 to
December 2013, 12,926 (65 %) were female, the median age was 33 years (interquartile
range (IQR): 27–39), and 42 % were in WHO clinical stage III and IV. Fig. 1 shows in detail the number and proportion of patients retained in care at IDI and
the reason for attrition during the 3 steps of the enrollment-to- treatment cascade.

Fig. 1. Patients retained and lost to program in the cascade from program enrollment to ART
initiation

Overall of the 19,774 patients, 2,717 (13.7 %) never had a CD4 count test (Step1),
of which 10.8 % were LTP; of the 17,057 retained who achieved a CD4 count test, 948
(5.8 %) did not return and therefore were not assessed for ART eligibility (Step 2).
Of the 16,109 assessed for ART 7,606 (46 %) were eligible for initiation, and of these
6,099 (80.2 %) were started on ART, while the remaining patients were LTP before ART
start. Overall after enrollment in our program a low proportion of patients (30.8 %)
were retained and started on ART. The median time from enrollment to CD4 count testing
was 25 days (IQR: 0–35) and from eligibility assessment to ART initiation was 56 days
(IQR: 36–112).

The overall cumulative probability of being LTP was 21 % (95 % CI: 20 % – 22 %) after
1 year, 30 % (95 % CI: 29 % – 31 %) after 3 years, and 35 % (95 % CI: 34 % – 36 %)
after 5 years from enrolment into care. The cumulative probabilities of being LTP
after 5 years was higher among males compared to females 38 % (95 % CI: 37 – 40 %),
versus 33 % (95 % CI: 32 % – 34 %), P??0.001 Fig. 2a, and was higher among patients not eligible for ART compared to patients eligible
36 % (95 % CI: 34 % – 37 %) versus 19 % (95 % CI: 18 %-20 %), P??0.001 Fig. 2b.

Fig. 2. Cumulative probability of being LTP a by gender b by CD4 count
^*

In the multivariable Cox proportional Hazards model, male gender (HR: 1.19, 95 % CI:
1.12-1.19) and clinical WHO stage 3 and 4 (HR: 1.20, 95 % CI: 1.13-1.27) were associated
with being LTP, while older age was protective (HR: 0.98, 95 % CI: 0.96-0.99 per 5 years
increase). Patients recently enrolled in the IDI program had a lower risk of being
LTP (Table 1).

Table 1. Factors associated with lost to program after enrolment into HIV care

Among patients with CD4 count test assessment, factors associated with being LTP were
similar (except for older age which was no longer protective): in addition patients
with higher CD4 count were more likely to be LTP with an HR of 1.03 (95 % CI 1.02
– 1.03) per 50 cell/?L increase.