Patterns and Predictors of Loss to Follow-Up Among Hypertensive and Diabetic Patients in PIH-Supported Clinics, Rwanda
1
Bill and Joyce Cummings Institute of Global Health, University of Global Health Equity, Kigali, Rwanda
Popul. Med. 2026;8(Supplement Supplement 1):A633
ABSTRACT
BACKGROUND:
Loss to follow-up (LTFU) threatens positive treatment outcomes of chronic noncommunicable disease (NCD). Although Rwanda has expanded nurse-led NCD services, drivers of LTFU in rural clinics are not well described. We estimated LTFU prevalence and identified associated factors associted with LTFU in a nurse led NCD program.
METHODS:
We conducted an analytical cross-sectional study (May–June 2025) at a district hospital and two affiliated health centres supported by Partners In Health. Adults (≥18 years) with hypertension and/or diabetes enrolled in the NCD treatment program were classified as LTFU (no clinic contact for ≥3 consecutive months in 2024, excluding known deaths/transfers) or non-LTFU. A sample of 276 participants were included in the study (138 in each group). Groups were compared using appropriate statistical tests and logistic regression was used to identify independent predictors of LTFU.
RESULTS:
Of 943 patients in the NCD treatment program, 259 (27.5%) met LTFU criteria; after excluding deaths and transfers, adjusted LTFU was 25.3% (95% CI 23.7–29.3). NLTFU participants reported higher mean diabetes knowledge and hypertension knowlege score campared to the LTFU group ( Diabetes knowlege score,16.45±3.0 vs 13.92±4.4; mean difference 2.53; p=0.002), ( Hypertension Knowledge score, 7.42±1.7 vs 6.77±2.0; mean difference 0.65; p=0.013). Satisfaction was modestly higher among NLTFU (26.89±2.28) than LTFU (25.67±4.88; mean difference 1.21; p=0.008). Prevalent reasons were distance (50.7%) and transport cost (47.8%). Predictors of LTFU were frequent travel (aOR 12.7; 95% CI 3.17–51.20), residential migration (aOR 22.3; 95% CI 1.84–272.53) and use of traditional medicine (aOR 14.8; 95% CI 1.55–141.70). Higher diabetes knowledge was associated with lower odds of LTFU (AOR 0.20; 95% CI 0.003–0.28) (all p≤0.019).
CONCLUSIONS:
Approximately one quarter of rural NCD patients enrolled in the NCD program experienced LTFU. Mobility, traditional medicine use, and limited diabetes knowledge were key contributors to LTFU, while satisfaction differences were small.
Loss to follow-up (LTFU) threatens positive treatment outcomes of chronic noncommunicable disease (NCD). Although Rwanda has expanded nurse-led NCD services, drivers of LTFU in rural clinics are not well described. We estimated LTFU prevalence and identified associated factors associted with LTFU in a nurse led NCD program.
METHODS:
We conducted an analytical cross-sectional study (May–June 2025) at a district hospital and two affiliated health centres supported by Partners In Health. Adults (≥18 years) with hypertension and/or diabetes enrolled in the NCD treatment program were classified as LTFU (no clinic contact for ≥3 consecutive months in 2024, excluding known deaths/transfers) or non-LTFU. A sample of 276 participants were included in the study (138 in each group). Groups were compared using appropriate statistical tests and logistic regression was used to identify independent predictors of LTFU.
RESULTS:
Of 943 patients in the NCD treatment program, 259 (27.5%) met LTFU criteria; after excluding deaths and transfers, adjusted LTFU was 25.3% (95% CI 23.7–29.3). NLTFU participants reported higher mean diabetes knowledge and hypertension knowlege score campared to the LTFU group ( Diabetes knowlege score,16.45±3.0 vs 13.92±4.4; mean difference 2.53; p=0.002), ( Hypertension Knowledge score, 7.42±1.7 vs 6.77±2.0; mean difference 0.65; p=0.013). Satisfaction was modestly higher among NLTFU (26.89±2.28) than LTFU (25.67±4.88; mean difference 1.21; p=0.008). Prevalent reasons were distance (50.7%) and transport cost (47.8%). Predictors of LTFU were frequent travel (aOR 12.7; 95% CI 3.17–51.20), residential migration (aOR 22.3; 95% CI 1.84–272.53) and use of traditional medicine (aOR 14.8; 95% CI 1.55–141.70). Higher diabetes knowledge was associated with lower odds of LTFU (AOR 0.20; 95% CI 0.003–0.28) (all p≤0.019).
CONCLUSIONS:
Approximately one quarter of rural NCD patients enrolled in the NCD program experienced LTFU. Mobility, traditional medicine use, and limited diabetes knowledge were key contributors to LTFU, while satisfaction differences were small.
| eISSN: | 2654-1459 |
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