Factors affecting defaulting from services among people living with HIV at two treatment centers in Western province, Sri Lanka

Introduction: Failure to retention in care or lost to follow up (LFU) is a challenge in the lifelong HIV care continuum as it results in adverse clinical and preventive outcomes. This study explores social and clinical factors that contribute to loss to follow up among PLHIV.
Objective: to describe factors affecting loss to follow up among PLHIV at two high-burden, treatment centers in the Western Province, Sri Lanka.
Method: A comparative cross-sectional study was conducted in STD clinics Colombo and Ragama. LFU was defined as failure to attend a given appointment for three months. PLHIV who were registered from February 2016 to February 2019 and were LFU at least once were chosen as the study population. PLHIV who continuously retained in care, in the same time period, were chosen for comparison by systematic sampling.  Socio demographic, clinical and LFU data were collected as secondary data, using a pre tested checklist and analyzed by SPSS. 
Results: Income levels, proportions of key populations and vulnerable populations, WHO stage and performance scale at registration were similar among both groups. 
Shorter distance to ART center, unknown serostatus of the regular partner, non-disclosure and absence of a treatment supporter were significantly associated with loss to follow up in this study population.  Disclosure status and the presence of a treatment supporter was significantly associated with success of defaulter tracing. 
Conclusion: It is important to consider non-disclosure, absence of a treatment supporter and partner’s serostatus when addressing loss to follow up among PLHIV.