Attrition and Loss to Follow-up Among Children and Adolescents in a Community Home-Based Care HIV Programme in Uganda

Massavon, William

doi:10.4172/2161-0665.1000183

Cited by 5 publications

(4 citation statements)

References 32 publications

(35 reference statements)

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“…In Uganda, the incidence of attrition was 14.4 per 100 person-years. 20 The pediatric West African Database to evaluate attrition from 2000 to 2008 included Benin, Côte d’Ivoire, Gambia, Ghana, Senegal, and Mali was 26.2 per 100 child-years. 6 In Kenya, Lesotho, Mozambique, Rwanda, and Tanzania, the incidence of attrition rate at primary health facilities was 15 per 100 person-years and at secondary and tertiary health facilities was 26.2 per 100 person-years.…”

Section: Discussionmentioning

confidence: 99%

“…The interval between the last clinic visit registered in the database was >6 months in the pediatric West African Database. 6 The study participants in Uganda were adolescents and children, 20 and the time frame/follow-up period, the heterogeneity of the study participants, and the types of clinical centers were also considered. This study had a long time frame/follow-up period.…”

Section: Discussionmentioning

confidence: 99%

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Incidence and predictors of attrition among children on antiretroviral therapy at University of Gondar Comprehensive Specialized Hospital, Northwest Ethiopia, 2019: Retrospective follow-up study

2022

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Objectives: Retaining on antiretroviral therapy is essential for reducing HIV-related morbidity and mortality. However, attrition in HIV-positive children remains a critical challenge in resource-limited settings, including Ethiopia. This study aims to determine the incidence and predictors of attrition among children on antiretroviral therapy at the University of Gondar Comprehensive Specialized Hospital, Northwest Ethiopia. Methods: An institution-based retrospective follow-up study was conducted among 357 HIV-positive children at the University of Gondar Comprehensive Specialized Hospital from 1 January 2005 to 30 December 2018 (G.C.). Data were collected by chart review using a structured and pre-tested data abstraction checklist. SPSS 22 and STATA 14.0 were used for data entry and analysis, respectively. In the Cox proportional hazard model, bivariables had a 0.25 computed to multivariable, and variables with a p-value of 0.05 at a 95% confidence interval were considered statistically significant predictors of attrition incidence. Results: A total of 344 child records with a completeness rate of 96.4% were reviewed and included in the analysis. The median follow-up period was 4.3 (interquartile range = 4.3 ± 4.7) years, and the median survival time was 132 months. The incidence rate of attrition was 6.6 per 100 person year observation (PYO) (95% confidence interval = 5.5, 8.0). In all, 105 (30.5%) children were recorded as attrition in the follow-up period. Baseline WHO clinical staging 3 and 4 (adjusted hazard ratio = 2.3 (95% confidence interval = 1.3, 4.0)), baseline weight-for-age −2 Z-score (adjusted hazard ratio = 3.1 (95% confidence interval = 1.7, 5.3)), cotrimoxazole non-users (adjusted hazard ratio = 2.5 (95% confidence interval = 1.4, 4.3)), and baseline hemoglobin levels 10 mg/dL (adjusted hazard ratio = 2.7 (95% confidence interval = 1.5, 47)) were found to be a predictor of attrition. Conclusion: The overall incidence of the rate of attrition was high. Baseline WHO clinical staging 3/4, baseline hemoglobin 10 mg/dL, cotrimoxazole (cotrimoxazole preventive therapy) non-user, and underweight at baseline (weight-for-age 2 Z-score) were found to be the main predictors of attrition.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Incidence and predictors of attrition among children on antiretroviral therapy at University of Gondar Comprehensive Specialized Hospital, Northwest Ethiopia, 2019: Retrospective follow-up study

2022

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“…A declined from 86% at 6 months to 77% by 36 months after ART initiation in sub Saharan Africa [4,5]. So, retention in care of adolescents with HIV remains a major operational challenge requiring innovation and creativity but data from low-or middle-income countries are scarce [6,7].…”

Section: Introductionmentioning

confidence: 99%

Predictors of Loss to Follow Up of Patients Enrolled on Antiretroviral Therapy: A Retrospective Cohort Study

Haile¹

2014

J AIDS Clin Res

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Introduction: There is a growing concern about the increasing rates of Loss to Follow up (LTFU) among people who are on HIV/AIDS treatment programs. It is more common in resource-poor settings. However little is known about the time to LTFU and predictors after Antiretroviral Therapy (ART) initiation in low resource settings including Ethiopia. Method: Retrospective cohort study was employed among a total of 520 records of patients who were enrolled on antiretroviral therapy in Aksum St. Marry hospital. Baseline patient records were extracted from electronic and paper based medical records database and analysed using Kaplan Meier survival and Cox proportional hazard model to identify the independent predictors of loss to follow up of patients on ART. Result: of 520 patients, 51(9.8%) were loss giving a LTFU rate of 8.2 per 100 person-years. From these LTFU, 21(41%) occurred within the first Six months of ART initiation. The independent predictors of LTFU of patient were being smear positive pulmonary TB [Adj.HR (95% CI)=(2.05 (1.02, 4.12)], male gender [Adj. HR (95%CI)=(2.73 (1.31, 5.66)], regiment AZT-3TC-NVP [Adj. HR (95%CI)=(3.47 (1.02,11.83)] and weight ≥60kg [Adj. HR (95% CI)=(3.47 (1.02,11.83)]. Conclusion: Substantial magnitude of loss to follow up has been found among patients on ART which significantly affect the overall outcome of HIV/AIDS program of treatment. The independent predictors identified were TB smear positive, male gender, regiment AZT-3TC-NVP and lower weight. So, continuous and comprehensive follow up is necessary to minimize loss to follow up and optimize treatment outcome of people on ART.

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“…Accordingly, the pooled incidence of LTFU among HIV-positive children on ART is found to be 2.79 (95% CI: 1.99, 3.91) per 100-child-year observations. The incidence is lower than the studies conducted in Asia (4.2 per 100 child years) [ 42 ], in Uganda (12.6 per 100 child years) [ 43 ], in Kenya (14.65 per 100 child years [ 44 ], in South Africa (10.8 per 100 person-years) [ 45 ], in Malawi (12.6/ per 100 person-years) [ 46 ], in Tanzania (18.2 per 100 person-years) [ 47 ], in South Africa (5.0 per 100 person-years) [ 48 ], in Nigeria (40 per 100 child-years) [ 49 ], in western Kenya (18.4 per 100 person-years) [ 50 ], in Côte d’Ivoire’s(9.3 per 100 person-years) [ 51 ] and in Mozambique (6.9/per 100 person-years) [ 52 ]. This can be justified that LTFU was considered when HIV-positive children interrupt ART treatment and with unknown tracing outcomes.…”

Section: Discussionmentioning

confidence: 68%

Incidence of lost to follow up among HIV-positive children on antiretroviral therapy in Ethiopia: Systematic review and meta-analysis

Girma,

Abita,

Lemu

et al. 2024

PLoS ONE

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Background At the end of 2022, globally, only 46% of children (aged 0–14 years) on ART had suppressed viral loads. Viral load suppression is crucial to reduce HIV-related deaths. To suppress the viral load at the expected level, children must be retained in ART treatment. Nevertheless, lost to follow-up from ART treatment continues to be a global challenge, particularly, in developing countries. Previously, primary studies were conducted in Ethiopia to assess the incidence of lost to follow-up among HIV-positive children on ART treatment. However, variations have been seen among the studies. Therefore, this systematic review and meta-analysis aimed to estimate the pooled incidence of lost to follow-up among HIV-positive children on ART and identify its associated factors in Ethiopia. Methods We searched PubMed, HINARI, Science Direct, Google Scholar, and African Journals Online to obtain articles published up to November 20, 2023. Critical appraisal was done using the Joanna Briggs Institute checklist. Heterogeneity was identified using I-square statistics. Funnel plot and Egger’s tests were used to identify publication bias. Data was presented using forest plots and tables. Random and fixed-effect models were used to compute the pooled estimate. Results Twenty-four studies were included in the final analysis. The pooled incidence of lost to follow-up among HIV-positive children on ART was 2.79 (95% CI: 1.99, 3.91) per 100-child-year observations. Advanced HIV disease (HR: 2.20, 95% CI: 1.71, 2.73), having opportunistic infection (HR: 2.59, 95% CI: 1.39; 4.78), fair or poor ART treatment adherence (HR: 2.92, 95% CI: 1.31; 6.54) and children aged between 1–5 years (HR: 2.1,95% CI: 1.44; 2.95) were factors associated with lost to follow up among HIV positive children on ART. Conclusions The overall pooled incidence of lost to follow-up among HIV-positive children on ART is low in Ethiopia. Therefore, counseling on ART drug adherence should be strengthened. Moreover, emphasis has to be given to children with advanced HIV stage and opportunistic infection to reduce the rate of lost to follow up among HIV-positive children on ART. Trial registration Registered in PROSPERO with ID: CRD42024501071.

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Attrition and Loss to Follow-up Among Children and Adolescents in a Community Home-Based Care HIV Programme in Uganda

Abstract: Background: We examine attrition and loss to follow-up (LTFU) and their baseline predictors among HIV-infected children and adolescents in a Community Home-Based Care (CHBC) model in Kampala (Uganda).

Cited by 5 publications

References 32 publications

Incidence and predictors of attrition among children on antiretroviral therapy at University of Gondar Comprehensive Specialized Hospital, Northwest Ethiopia, 2019: Retrospective follow-up study

Incidence and predictors of attrition among children on antiretroviral therapy at University of Gondar Comprehensive Specialized Hospital, Northwest Ethiopia, 2019: Retrospective follow-up study

Predictors of Loss to Follow Up of Patients Enrolled on Antiretroviral Therapy: A Retrospective Cohort Study

Incidence of lost to follow up among HIV-positive children on antiretroviral therapy in Ethiopia: Systematic review and meta-analysis

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