Factors Associated with Loss to Follow-Up (LtFU) among People Living with HIV/AIDS
Abstract
Loss to follow-up (LtFU) among people living with HIV/AIDS (PLWHA) receiving antiretroviral (ARV) therapy remains a significant challenge, contributing to treatment failure, drug resistance, and ongoing HIV transmission. This study aimed to identify factors associated with LtFU among PLWHA on ARV therapy in Demak Regency. Method: A quantitative observational analytic study with a cross-sectional design was conducted among 199 PLWHA meeting inclusion criteria. Data were collected using validated questionnaires addressing knowledge, attitudes, perceptions, family support, peer support, stigma, healthcare worker support, quality of health services, access to services, and health service policies. Data were analyzed using SPSS with univariate analysis, bivariate chi-square tests, and multivariate logistic regression at a 0.05 significance level with 95% confidence intervals (CI). Results in bivariate analysis indicated that all independent variables were significantly associated with LtFU (p < 0.05). Multivariate analysis identified six independent predictors: poor knowledge (OR = 4.68; 95% CI: 1.57–13.94), negative attitude (OR = 5.65; 95% CI: 1.98–16.08), poor perception (OR = 4.95; 95% CI: 1.69–14.45), inadequate family support (OR = 14.40; 95% CI: 3.75–55.37), poor service quality (OR = 4.40; 95% CI: 1.54–12.62), and a weak health service system reflecting limited access and provider support (OR = 5.61; 95% CI: 1.79–17.57). Collectively, these factors explained 72.65% of the variation in LtFU. In conclusion, LtFU is driven by a combination of cognitive, psychosocial, and structural determinants, with family support and health system factors being the most influential. Effective interventions should prioritize enhancing family involvement, patient education, and counselling, as well as improving service accessibility, quality, and responsiveness to ensure sustained retention in HIV care.
Keywords: Antiretroviral, HIV/AIDS, Loss to Follow-Up, Risk Factors.
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Abugah, M., & Yabelang, A. M. (2025). Predictors of loss to follow-up among people living with HIV on antiretroviral therapy in a rural health facility using paper-based records. Frontiers in Public Health, 13(August), 1–13. https://doi.org/10.3389/fpubh.2025.1623805
Ahmed, C. V, Doyle, R., Gallagher, D., Imoohi, O., Ofoegbu, U., Wright, R., Yore, M. A., Brooks, M. J., Flores, D. D., Lowenthal, E. D., Rice, B. M., & Buttenheim, A. M. (2023). A Systematic Review of Peer Support Interventions for Adolescents Living with HIV in Sub-Saharan Africa. AIDS Patient Care and STDs, 37(11), 535–559. https://doi.org/10.1089/apc.2023.0094
Alizade, M., Farshbaf‑Khalil, A., Malakouti, J., & Mirghafourvand, M. (2021). Predictors of preventive behaviors of AIDS/HIV based on Health Belief Model constructs in women with high‑risk sexual behaviors: A cross‑sectional survey. Journal of Education and Health Promotion, 10(January), 1–6. https://doi.org/10.4103/jehp.jehp
Andriani, N. K., Aulia, U., & Irwan. (2024). Faktor yang Mempengaruhi Lost to Follow-Up Pasien HIV-AIDS dengan Terapi ARV pada Kelompok LSL. Preventif: Jurnal Kesehatan Masyarakat, 15(1), 94–114. https://doi.org/10.22487/preventif.v15i1.1351
Arisudhana, G. A. B., & Artati, L. P. N. (2022). Korelasi Stigma dengan Lost To-Follow Up pada Orang Dengan HIV dan AIDS. Journal Nursing Research Publication Media (NURSEPEDIA), 1(3), 152–160. https://doi.org/10.55887/nrpm.v1i3.24
Baleeta, K., Muhwezi, A., Tumwesigye, N., Kintu, B. N., Riese, S., Byonanebye, D., Mbonye, M., Mwehire, D., Iriso, R., Ayebazibwe, B., Bailey, L., Lopez, D., Mcgough, L., Etukoit, M., & Nantamu, D. (2023). Factors that influence the satisfaction of people living with HIV with differentiated antiretroviral therapy delivery models in East Central Uganda : a cross ‑ sectional study. BMC Health Services Research, 1–11. https://doi.org/10.1186/s12913-023-09114-2
Bankere, A. W., Daba, S. G., Ami, B., Gedefa, L. K., & Lencha, B. (2024). Loss to follow- up and its predictors among children living with HIV on antiretroviral therapy , southern Oromia , Ethiopia : a 5- year retrospective cohort study. BMJ Open, 14(e078370.), 1–9. https://doi.org/10.1136/bmjopen-2023-078370
Beres, L. K., Mody, A., Sikombe, K., Nicholas, L. H., Schwartz, S., Eshun-Wilson, I., Somwe, P., Simbeza, S., Pry, J. M., Kaumba, P., McGready, J., Holmes, C. B., Bolton-Moore, C., Sikazwe, I., Denison, J. A., & Geng, E. H. (2021). The effect of tracer contact on return to care among adult, “lost to follow-up” patients living with HIV in Zambia: an instrumental variable analysis. Journal of the International AIDS Society, 24(12). https://doi.org/10.1002/jia2.25853
Cristina, F., Santos, D., Apiruknapanond, P., Wang, T., Dawson, C., Valencia, C. P., Christine, M., Davey, H., Solís, S., Emilia, B., Sabone, M., Makhado, L., Phillips, J. C., Corless, I. B., Shaibu, S., Ti, W., Diane, C., Maria, S., Cuca, Y. P., & Schnall, R. (2025). Global Measures of HIV Care Accessibility Across Urban , Suburban , and Rural Areas. Journal of Urban Health, 0123456789. https://doi.org/10.1007/s11524-025-01021-7
Dayyab, F. M., Mukhtar, F., Iliyasu, G., & Habib, A. G. (2021). Determinants of loss to follow-up among people living with HIV on antiretroviral therapy in Nigeria. African Journal of AIDS Research, 20(1), 93–99. https://doi.org/10.2989/16085906.2021.1874444
Deeks, S. G., Archin, N., Cannon, P., Collins, S., Jones, R. B., de Jong, M. A. W. P., Lambotte, O., Lamplough, R., Ndung’u, T., Sugarman, J., Tiemessen, C. T., Vandekerckhove, L., & Lewin, S. R. (2021). Research priorities for an HIV cure: International AIDS Society Global Scientific Strategy 2021. Nature Medicine, 27(12), 2085–2098. https://doi.org/10.1038/s41591-021-01590-5
Dessie, Z. G., & Zewotir, T. (2024). HIV-related stigma and associated factors : a systematic review and meta-analysis. Frontiers in Public Health, 12(1356430), 1–12. https://doi.org/10.3389/fpubh.2024.1356430
Dhir, A. M. (2025). Interventions for stigma reduction in HIV treatment and prevention designed to enhance antiretroviral uptake and adherence : A systematic review. Plos Global Public Health, 5(5), 1–21. https://doi.org/10.1371/journal.pgph.0004604
Edwards, J., Soyer, S., Jack, N., Boyce, G., Edwards, R. J., Ayoung, V., & Todd, S. (2025). A Cross-Sectional Client Satisfaction Study Among Persons Living with HIV Attending a Large HIV Treatment Centre in Trinidad. Healthcare, 13(1400), 1–14. https://doi.org/10.3390/healthcare13121400
Endebu, T., Taye, G., & Deressa, W. (2024). Rate and predictors of loss to follow-up in HIV care in a low-resource setting: analyzing critical risk periods. BMC Infectious Diseases, 24(1). https://doi.org/10.1186/s12879-024-10089-6
Gebremichael, M. A., Gurara, M. K., Weldehawaryat, H. N., Mengesha, M. M., & Berbada, D. A. (2021). Predictors of Loss to Follow-Up among HIV-Infected Adults after Initiation of the First-Line Antiretroviral Therapy at Arba Minch General Hospital , Southern Ethiopia : A 5-Year Retrospective Cohort Study. BioMed Research International, 8659372, 1–12. https://doi.org/10.1155/2021/8659372
Hoang, N. T., Foo, T. J., Tran, B. X., Do, N. T., Vu, G. T., Nguyen, C. T., Pham, H. Q., Latkin, C. A., Ho, C. S. H., & Ho, R. C. M. (2022). Structural barriers for retention of HIV/AIDS patients after initiating antiretroviral therapy in outpatient clinics of Vietnam. AIDS Care, 34(8), 992–999. https://doi.org/10.1080/09540121.2021.1929816
Kebede, H. K., Mwanri, L., Ward, P., & Gesesew, H. A. (2021). Predictors of lost to follow up from antiretroviral therapy among adults in sub ‑ Saharan Africa : a systematic review and meta ‑ analysis. Infectious Diseases of Poverty, 10(33), 1–18. https://doi.org/10.1186/s40249-021-00822-7
Kemenkes RI. (2025). Laporan Eksekutif Perkembangan HIV AIDS dan Penyakit Infeksi Menular Seksual (PIMS). Kemenkes RI.
Klau, N., Id, F., Id, L. M., Hawke, K., & Ward, P. R. (2022). Traditional Human Immunodeficiency Virus treatment and family and social influence as barriers to accessing HIV care services in Belu , Indonesia. Plos Oke, 17(7), 1–16. https://doi.org/10.1371/journal.pone.0264462
Knight, L., & Schatz, E. (2022). Social Support for Improved ART Adherence and Retention in Care among Older People Living with HIV in Urban South Africa : A Complex Balance between Disclosure and Stigma. International Journal of Environmental Research and Public Health, 19(11472), 1–16. https://doi.org/https://doi.org/10.3390/ijerph191811473
Kurniawan, R., Pratiwi, R. D., & Suyono, S. (2022). Faktor-faktor determinan penyebab loss to follow up pada orang dengan HIV dan AIDS (ODHA) yang menerima terapi Antiretroviral (ARV). Holistik Jurnal Kesehatan, 16(6), 485–494. https://doi.org/10.33024/hjk.v16i6.7820
Mandawa, M. B., & Mahiti, G. R. (2022). Factors Contributing to Loss to Follow-Up from HIV Care Among Men Living with HIV/AIDS in Kibaha District, Tanzania. HIV/AIDS - Research and Palliative Care, 14(October), 503–516. https://doi.org/10.2147/HIV.S381204
Mlangeni, N., Lembani, M., Adetokunboh, O., & Nyasulu, P. S. (2025). Structural barriers and facilitators to accessing HIV services for marginalized working populations : insights from farm workers in South Africa. Health Policy and Planning, 40(00), 75–84. https://doi.org/10.1093/heapol/czae098
Muchtar, R. S. U., Natalia, S., & Usnah, A. (2023). Faktor – Faktor Yang Berhubungan Dengan Kepatuhan Minum Obat Arv Pada Pasien Hiv/Aids Di Puskesmas Lubuk Baja. Warta Dharmawangsa, 17(1), 53–64. https://doi.org/10.46576/wdw.v17i1.2922
Mufidah, D. (2025). Hubungan Stigma Sosial dengan Perilaku Lost to Follow-Up Pasien HIV / AIDS dengan Terapi ARV. Media Husada Journal of Nursing Science, 6(3), 200–205. https://doi.org/10.33475/mhjns.v6i3.907
Mugenyi, L., Nanfuka, M., Byawaka, J., Agaba, C., Mijumbi, A., Kagimu, D., Mugisha, K., Shabbar, J., & Etukoit, M. (2022). Effect of universal test and treat on retention and mortality among people living with HIV- infection in Uganda : An interrupted time series analysis. Plos One, 12757, 1–13. https://doi.org/10.1371/journal.pone.0268226
Mukarromah, S., & Azinar, M. (2021). Penghambat Kepatuhan Terapi Antiretroviral pada Orang dengan HIV/AIDS (Studi Kasus pada Odha Loss To Follow Up Therapy). Indonesian Journal of Public Health and Nutrition, 1(3), 396–406. https://doi.org/10.15294/ijphn.v1i3.47892
Øgård-Repål, A., Berg, R. C., & Fossum, M. (2023). Peer Support for People Living With HIV: A Scoping Review. Health Promotion Practice, 24(1), 172–190. https://doi.org/10.1177/15248399211049824
Perger, T., Davtyan, M., Foster, C., Evangeli, M., Berman, C., Kacanek, D., Puga, A. M., Sekidde, S., & Bhopal, S. (2025). Impact of HIV ‑ Related Stigma on Antiretroviral Therapy Adherence , Engagement and Retention in HIV Care , and Transition to Adult HIV Care in Pediatric and Young Adult Populations Living With HIV : A Literature Review. AIDS and Behavior, 29(2), 497–516. https://doi.org/10.1007/s10461-024-04534-5
Putri, N. F., Tanesib, A. J., & Herdayanti, M. (2025). Determinan Kejadian Loss to Follow Up (LtFU) Pengobatan Antiretroviral (ARV) pada Pasien HIV/AIDS di RS “X” Kota Depok. Jurnal Epidemiologi Kesehatan Komunitas, 10(3), 34–41. https://doi.org/10.14710/jekk.v10i3.2690
Salbila, I., & Usiono, U. (2023). Strategi Pencegahan HIV & AIDS: Langkah-Langkah Efektif Untuk Masyarakat. Jurnal Kesehatan Tambusai, 4(4), 5630–5639. https://doi.org/10.31004/jkt.v4i4.19941
Salimo, Z. M., Avelino-Silva, V. I., Silva, E. F. da, Chaves, Y. O., Kadri, M. R. de A. El, Nogueira, P. A., & Benzaken, A. S. (2025). Factors related to loss to follow-up among people living with HIV: a systematic review. Revista Do Instituto de Medicina Tropical de Sao Paulo, 67, e53. https://doi.org/10.1590/S1678-9946202567053
Seunanden, T. C., Ngwenya, N., & Seeley, J. (2025). Experiences and perceptions on antiretroviral therapy adherence and non ‑ adherence : a scoping review of young people living with HIV in sub ‑ Saharan Africa. BMC Public Health, 25(1450). https://doi.org/10.1186/s12889-025-22579-6
Shivambu, S., Ngcobo, S., & Sciences, H. (2023). Perceptions and experiences of HIV care retention during the first 12 months at Kanyamazane CHC. Southern African Journal of Infectious Diseases, 40(1), 1–12. https://doi.org/10.4102/sajid.v40i1.752
Shrestha, A., Poudel, L., Adhikari, B., Bhandari, S., Shrestha, R., Kunwar, R. S., Pandey, L. R., KC, M. B., Wilson, E. C., & Deuba, K. (2025). Determinants of loss to follow-up among people living with HIV receiving antiretroviral therapy in a universal test and treat setting: A retrospective cohort study in Nepal. Public Health in Practice, 10, 100634. https://doi.org/10.1016/j.puhip.2025.100634
Supriyatni, N., Salim, L. A., Hargono, A., & Febriyanti, F. (2023). Antiretroviral medication adherence for people with HIV/AIDS. Journal of Public Health in Africa, 14(7), 2434. https://doi.org/10.4081/jphia.2023.2434
Tchakoute, C. T., Rhee, S. Y., Hare, C. B., Shafer, R. W., & Sainani, K. (2022). Adherence to contemporary antiretroviral treatment regimens and impact on immunological and virologic outcomes in a US healthcare system. PLoS ONE, 17(2), 1–12. https://doi.org/10.1371/journal.pone.0263742
Tekle, A., Tsegaye, A., & Ketema, T. (2024). Adherence to Anti-Retroviral Therapy (ART) and Its Determinants Among People Living with HIV/ AIDS at Bonga, Kaffa, South-West Ethiopia. Patient Preference and Adherence, 18(March), 543–554. https://doi.org/10.2147/PPA.S445164
Tiffany, E., & Yuniartika, W. (2023). Efektifitas Terapi Antiretroviral Terhadap Pasien HIV (Literature Review). Jurnal Multidisiplin West Science, 2(05), 364–373. https://doi.org/10.58812/jmws.v2i5.346
Timilsina, A., Shrestha, A., Neupane, P., Nepal, S., Kandel, B., Devkota, S., & Thapa, S. (2024). HIV Care Seeking Pathways and Barriers to the Continuum of Care Faced by Persons Living With HIV in Rural Nepal : A Qualitative Study. Health Expectations ORIGINAL, 28(e70141), 1–11. https://doi.org/10.1111/hex.70141
UNAIDS. (2025). 2024 Global AIDS Report — The Urgency of Now: AIDS at a Crossroads. UNAIDS. https://www.unaids.org/en/resources/documents
World Health Organization (WHO). (2025). HIV statistics, globally and by WHO region. Who. https://cdn.who.int/media/docs/default-source/hq-hiv-hepatitis-and-stis-library/hiv-epi-fact-sheet-march-2025.pdf?sfvrsn=61d39578_12
Wulandari, E. A., & Rukmi, D. K. (2021). Hubungan Tingkat Pengetahuan dengan Kepatuhan Terapi ARV pada ODHA di Yogyakarta The Correlation between The Level of Knowledge and The Adherence on ARV Therapy of ODHA in Yogyakarta Program Studi Ilmu Keperawatan , Fakultas Kesehatan , Universitas Jender. Jurnal Keperawatan Klinis Dan Komunitas, 5(3), 157–166. https://doi.org/10.22146/jkkk.49663
DOI: http://dx.doi.org/10.30829/contagion.v8i1.27723
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