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Lost to follow-up (LTFU), defined as interrupting anti-TB treatment for ≥ 8 consecutive weeks or missing anti-retroviral therapy (ART) appointments for > 90 days, is a barrier to TB/HIV coinfection management. Poor treatment adherence, a driver of multidrug resistance in TB/HIV, poses critical challenges to case management. Overestimating effect sizes when considering mutually exclusive events, like LTFU from ART and anti-TB treatment, can occur if sources of error are not properly accounted for in competing events. However, studies estimating the effect sizes of predictors of time to LTFU using competing risk analysis are scarce. Hence, this study aimed to investigate the predictors of time to LTFU among adults with TB/HIV coinfection. We conducted a multicenter facility-based retrospective follow-up study. We randomly selected 471 TB/HIV coinfected adults. Data were extracted using standardised checklists. The LTFUs from ART and anti-TB treatment were events of interest and competing events, respectively, and others were censored. The data were entered into Epi data and then exported to Stata and Rstudio. Statistical differences were tested by Gray’s test, and the cumulative incidence of each event was estimated by a cumulative incidence function. Bivariable and multivariable competing risk regression models were fitted, and variables with p values < 0.05 were considered significant predictors. Incidence rates of LTFU for ART and TB treatment were 3.90 and 19.17 per 1000 person-months of observation (PMOs), respectively. The predictors of ART LTFU included rural residence (adjusted subdistribution hazard ratio (SDHR): 3.39), WHO stage IV (SDHR: 2.88), haemoglobin < 11 g/dl (SDHR: 3.56), and opportunistic infections (OIs) (SDHR: 3.65). For TB treatment LTFU, significant predictors were rural residence (SDHR: 0.11), divorced (SDHR: 2.81), widowed (SDHR: 5.92), BMI < 18.5 (SDHR: 0.41), ambulatory functional status (SDHR: 2.59), adverse drug effects (SDHR: 2.87), and poor ART adherence (SDHR: 5.72). Considering errors in competing events, ART LTFU was higher among rural dwellers, individuals with advanced disease, nutritional deficits, or adverse drug effects requiring prioritised, multifaceted interventions. Targeted strategies such as intensified monitoring, adherence counselling, nutritional support, proactive management of drug-related side effects, marital instability, OIs and poor ART adherence should be integrated into the existing ART/TB program to mitigate LTFU.

Retaining adolescents (aged 10–19 years), living with HIV (ALHIV) on antiretroviral therapy (ART) is challenging. In Myanmar, 1269 ALHIV were under an Integrated HIV Care (IHC) Programme by June 2017 and their attrition (death and lost to follow-up) rates were not assessed before. We undertook a cohort study using routinely collected data of ALHIV enrolled into HIV care from July 2005 to June 2017 and assessed their attrition rates in June 2018 by time-to-event analysis. Of 1269 enrolled, 197(16%) and of 1054 initiated ART, 224 (21%) had an attrition defining event. The pre-ART and ART attrition rates were 21.8 (95% CI 19.0–25.1) and 6.4 (95% CI 5.6–7.3) per 100 person-years follow-up, respectively. The factors 'at enrolment' that were associated with higher hazards of attrition were: (1) WHO stage 3 or 4; (2) haemoglobin < 10 gm/dl; (3) no documented CD4 cell counts, hepatitis B and C test results; and (4) injection drug use. Baseline hazards were high during the initial 1–2 years and after 5–6 years. The pre-ART and ART attrition rates in ALHIV were lower than those in Africa but higher than the children under IHC. This warrants designing and implementing additional care tailored to the needs of ALHIV under IHC.

Background: No previous correlation between phenotype at diagnosis of Crohn’s disease (CD) and mortality has been performed. We assessed the predictive value of phenotype at diagnosis on overall and disease related mortality in a European cohort of CD patients. Methods: Overall and disease related mortality were recorded 10 years after diagnosis in a prospectively assembled, uniformly diagnosed European population based inception cohort of 380 CD patients diagnosed between 1991 and 1993. Standardised mortality ratios (SMRs) were calculated for geographic and phenotypic subgroups at diagnosis. Results: Thirty seven deaths were observed in the entire cohort whereas 21.5 deaths were expected (SMR 1.85 (95% CI 1.30–2.55)). Mortality risk was significantly increased in both females (SMR 1.93 (95% CI 1.10–3.14)) and males (SMR 1.79 (95% CI 1.11–2.73)). Patients from northern European centres had a significant overall increased mortality risk (SMR 2.04 (95% CI 1.32–3.01)) whereas a tendency towards increased overall mortality risk was also observed in the south (SMR 1.55 (95% CI 0.80–2.70)). Mortality risk was increased in patients with colonic disease location and with inflammatory disease behaviour at diagnosis. Mortality risk was also increased in the age group above 40 years at diagnosis for both total and CD related causes. Excess mortality was mainly due to gastrointestinal causes that were related to CD. Conclusions: This European multinational population based study revealed an increased overall mortality risk in CD patients 10 years after diagnosis, and age above 40 years at diagnosis was found to be the sole factor associated with increased mortality risk.