O-54 Loss to follow-up in HIV care: a retrospective analysis in Belize City, 2019–2024
Author(s):
M Arthurs, V Tuyud
Type Of Study:
- Analytical Study
- Descriptive Study
Year of Presentation:
2026
Objectives: 1. To quantify the burden of Loss to Follow-Up
(LTFU) among people living with HIV (PLHIV) who initiated ART in Belize City between 2019 and 2024, using the
standard definition of LTFU (90 days after ART is expected
to run out) and assess the frequency of multiple LTFU episodes to capture patterns of recur-rent disengagement; 2.
Identify age and gender groups most affected by LTFU; 3.
Determine which health facilities had the highest and lowest
proportions of LTFU; 4. Determine the duration from ART
initiation to the first documented episode of LTFU among
patients in the cohort; 5. Provide evidence-based recommendations for strengthening patient retention, through
en-hanced monitoring, clinic-level support strategies, and
surveillance system improvements.
Methods: A descriptive analysis was conducted using data from the Belize Health Information System. The study included persons initiating antiretroviral therapy (ART) in Belize City from January 2019 to December 2024. LTFU was defined as failure to return within 90 days of the expected medication pickup date. Demographic characteristics, treatment timelines, and time to first disengagement were assessed. Facility-level performance was evaluated using disengagement episodes per 100 ART dispensations.
Results: Among 244 persons initiating treatment, 85 (35%) were LTFU. Most disengagement occurred early, with 57 (67%) LTFU within the first 12 months, including peaks at months four and five. Females aged 20-29 accounted for the largest affected subgroup. Cleopatra White Health Centre and the national referral hospital recorded the highest absolute numbers of disengagement episodes, while facilities outside Belize City had the highest rate, at four episodes per 100 dispensations. Nearly one quarter of individuals experienced recurrent disengagement.
Conclusion: High and early LTFU cases in Belize City reflects a critical weakness in the HIV treatment cascade, limiting progress toward national and global targets. The concentration of disengagement among young women raises concerns about sustained community transmission and preventable infant infections. Targeted, timely interventions such as strengthened adherence counselling, peer-support models, systematic re-engagement protocols, and routine surveillance alerts are essential to mitigate early disengagement and improve long-term retention in care.