Death and Seeking Alternative Therapy Largely Accounted for Lost to Follow-up of Patients on ART in Northwest Ethiopia: A Community Tracking Survey

Abstract

BackgroundAntiretroviral treatment programs in sub-Saharan African countries are highly affected by LTF. Tracking patients lost to follow-up and understanding their status is essential to maintain program quality and to develop targeted interventions to prevent LTF. We aimed to determine the outcome and factors associated with LTF.MethodA lost to follow-up community tracking survey was conducted to determine the reasons, outcomes and factors associated with LTF at the University of Gondar Hospital, northwest Ethiopia. All patients were tracked at home to ascertain outcome status for lost to follow-up (death and non-death losses).ResultOut of the 551 patients LTF, 486 (88.20%) were successfully tracked. Death was the most common reason accounted for 233 (47.94%) of the lost to follow-up. Reasons for non-deaths losses include: stopped antiretroviral treatment due to different reasons, 135(53.36%), and relocation to another antiretroviral treatment program by self- transfer, 118(46.64%). The rate of mortality in the first six months was 72.12 per 100 person-years (95% CI: 61.80–84.24) but this sharply decreased after 12 months to 7.92 per 100 person-years (95% CI: 4.44–14.41). Baseline clinical characteristics were strongly associated with mortality.ConclusionDeath accounts for about half of the loss to follow up. Most deaths occur in the first six months of loss. Seeking alternative therapy is another major reason for loss to follow up. Early tracking mechanisms are necessary to prevent death.

Discontinuation from Antiretroviral Therapy: A Continuing Challenge among Adults in HIV Care in Ethiopia: A Systematic Review and Meta-Analysis

“…Table 1 presents the main characteristics and outcomes of reviewed studies[7–10,23,28–30,39]. Studies were conducted from across Ethiopia and the majority of them were from the northern (4) and southern (3) part of the nation.…”

“…The studies were analytical in type including: three case control studies[7,9,23], five retrospective cohort studies[8,10,29,30,39] and one prospective cohort study[28]. The majority of the studies (n = 7)[8–10,28–30,39] assessed factors associated with LTFU and the remaining two studies[7,23] assessed defaulting. One study that assessed LTFU[28] also assessed ‘stopped treatment’.…”

“…Three case-control studies[7,9,23] met seven out of nine JBI critical appraisal criteria, and six cohort studies[8,10,28–30,39] met eight out of nine JBI critical appraisal criteria. S2 Table presents outcome of the quality appraisal of each studies.…”

“…Four studies[10,28,29,39] considered LTFU when HIV positive patients on ART treatment had missed three or more monthly clinical appointments and not yet been classified as “dead” or “transferring out”. One study[8] measured LTFU when adult patients were one month late for their appointment to pick-up their antiretroviral drugs whereas one other study[9] defined LTFU when patients had missed two or more clinical appointments.…”

“…All studies assessed the relationship of age with discontinuation. All studies have measured the association of age and discontinuation, and 3 studies[10,30,39] found that patient’s age had significant association with discontinuation. Similarly, all studies have assessed the relationship between sex and discontinuation, and four studies[8,28,30,39] found a significant association.…”