{"doi":"10.1093/cid/ciaa1501","title":"Patient-reported Reasons for Stopping Care or Switching Clinics in Zambia: A Multisite, Regionally Representative Estimate Using a Multistage Sampling-based Approach in Zambia","abstract":"BACKGROUND: Understanding patient-reported reasons for lapses of retention in human immunodeficiency virus (HIV) treatment can drive improvements in the care cascade. A systematic assessment of outcomes among a random sample of patients lost to follow-up (LTFU) from 32 clinics in Zambia to understand the reasons for silent transfers and disengagement from care was undertaken. METHODS: We traced a simple random sample of LTFU patients (>90 days from last scheduled visit) as determined from clinic-based electronic medical records from a probability sample of facilities. Among patients found in person, we solicited reasons for either stopping or switching care and predictors for re-engagement. We coded reasons into structural, psychosocial, and clinic-based barriers. RESULTS: Among 1751 LTFU patients traced and found alive, 31% of patients starting antiretroviral therapy (ART) between 1 July 2013 and 31 July 2015 silently transferred or were disengaged (40% male; median age, 35 years; median CD4 level, 239 cells/μL); median time on ART at LTFU was 480 days (interquartile range, 110-1295). Among the 544 patients not in care, median prevalences for patient-reported structural, psychosocial, and clinic-level barriers were 27.3%, 13.9%, and 13.4%, respectively, and were highly variable across facilities. Structural reasons, including, \"relocated to a new place\" were mostly cited among 289 patients who silently transferred (35.5%). We found that men were less likely to re-engage in care than women (odds ratio, .39; 95% confidence interval, .22-.67; P = .001). CONCLUSIONS: Efforts to improve retention of patients on ART may need to be tailored at the facility level to address patient-reported barriers.","journal":"Clinical Infectious Diseases","year":2020,"id":94427,"datarank":0.0,"base_score":0.0,"endowment":0.0,"self_citation_contribution":0.0,"citation_network_contribution":0.0,"self_endowment_contribution":0.0,"citer_contribution":0.0,"corpus_percentile":null,"corpus_rank":null,"citation_count":38,"citer_count":0,"citers_with_citation_signal":0,"citers_with_endowment":0,"datacite_reuse_total":0,"is_dataset":false,"is_dataset_confidence":0.9339,"is_data_producer":false,"deposit_databanks":null,"is_oa":true,"file_count":0,"downloads":0,"has_version_chain":false,"published_date":"2020-01-01","fair_score":null,"fair_percentile":null,"algorithm_id":"datarank_citation_only_1hop_v6","ranking_scope":"data_only","authors":[{"id":371001,"name":"Ingrid Eshun‐Wilson","orcid":"0000-0002-4049-9868","position":1,"is_corresponding":false},{"id":361251,"name":"Kombatende Sikombe","orcid":"0000-0002-8187-8661","position":2,"is_corresponding":false},{"id":370998,"name":"Laura K. Beres","orcid":"0000-0002-4731-7828","position":3,"is_corresponding":false},{"id":377511,"name":"Paul Somwe","orcid":null,"position":4,"is_corresponding":false},{"id":370997,"name":"Aaloke Mody","orcid":"0000-0003-3787-365X","position":5,"is_corresponding":false},{"id":370999,"name":"Sandra Simbeza","orcid":"0000-0002-0150-3369","position":6,"is_corresponding":false},{"id":470247,"name":"Chama Bukankala","orcid":"0000-0003-1330-3521","position":7,"is_corresponding":false},{"id":316641,"name":"David V. Glidden","orcid":"0000-0001-5888-1419","position":8,"is_corresponding":false},{"id":415447,"name":"Lloyd Mulenga","orcid":"0000-0002-1044-4209","position":9,"is_corresponding":false},{"id":294524,"name":"Nancy Padian","orcid":"0000-0003-1046-2287","position":10,"is_corresponding":false},{"id":375967,"name":"Peter Ehrenkranz","orcid":"0000-0003-2028-4779","position":11,"is_corresponding":false},{"id":371004,"name":"Carolyn Bolton‐Moore","orcid":"0000-0001-9103-7746","position":12,"is_corresponding":false},{"id":371003,"name":"Charles B. Holmes","orcid":"0000-0002-7924-6761","position":13,"is_corresponding":false},{"id":371005,"name":"Elvin Geng","orcid":"0000-0002-0825-1424","position":14,"is_corresponding":false},{"id":299399,"name":"Izukanji Sikazwe","orcid":"0000-0002-3898-2607","position":0,"is_corresponding":true}],"reference_count":41,"raw_metadata":null,"created_at":"2026-07-18T22:32:04.778261Z","pmid":"33011803","pmcid":null,"fwci":null,"citation_percentile":null,"influential_citations":0,"oa_status":null,"license":null,"views":0,"total_file_size_bytes":0,"version_count":0,"fair_f":null,"fair_a":null,"fair_i":null,"fair_r":null,"fair_zscore":null,"fair_rationale":null,"fair_model":null,"fair_agent_version":null,"fair_fulltext_source":null,"fair_has_llm":null,"fair_computed_at":null,"clinical_trials":[],"software_tools":[],"db_accessions":[],"linked_datasets":[],"topics":[]}