Incidence and predictors of attrition among children attending antiretroviral follow-up in public hospitals, Southern Ethiopia, 2020: a retrospective study

Bimer, Kirubel; Sebsibe, Girum; Desta, Kalkidan Wondwossen; Zewde, Ashenafi; Sibhat, Migbar

doi:10.1136/bmjpo-2021-001135

Cited by 6 publications

(16 citation statements)

References 29 publications

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“… 19 In contrast, the incidence of attrition in this study was higher compared with other studies. 14 15 20 Variation in incidence between countries in SSA is caused by differences in access to and quality of healthcare services, health-seeking behaviours between populations, 21 heterogeneity in methodology and definition of outcomes. Finally, it is possible that the LTFUs registered in our study may be due to undocumented mortality instead of disengagement from care or undocumented transfers.…”

Section: Discussionmentioning

confidence: 99%

Attrition and associated factors among children living with HIV at a tertiary hospital in Eritrea: a retrospective cohort analysis

Mengistu

Ghebremeskel

Rezene

et al. 2022

bmjpo

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BackgroundReducing attrition in paediatric HIV-positive patients using combined antiretroviral therapy (cART) programmes in sub-Saharan Africa is a challenge. This study explored the rates and predictors of attrition in children started on cART in Asmara, Eritrea.MethodsThis was a retrospective cohort study using data from all paediatric patients on cART between 2005 and 2020, conducted at the Orotta National Referral and Teaching Hospital. Kaplan-Meier estimates of the likelihood of attrition and multivariate Cox proportional hazards models were used to assess the factors associated with attrition. All p values were two sided and p<0.05 was considered statistically significant.ResultsThe study enrolled 710 participants with 374 boys (52.7%) and 336 girls (47.3%). After 5364 person-years’ (PY) follow-up, attrition occurred in 172 (24.2%) patients: 65 (9.2%) died and 107 (15.1%) were lost to follow-up (LTFU). The crude incidence rate of attrition was 3.2 events/100 PY, mortality rate was 2.7/100 PY and LTFU was 1.2/100 PY. The independent predictors of attrition included male sex (adjusted HR (AHR)=1.6, 95% CI: 1 to 2.4), residence outside Zoba Maekel (AHR=1.5, 95% CI: 1 to 2.3), later enrolment years (2010–2015: AHR=3.2, 95% CI: 1.9 to 5.3; >2015: AHR=6.1, 95% CI: 3 to 12.2), WHO body mass index-for-age z-score <−2 (AHR=1.4, 95% CI: 0.9 to 2.1), advanced HIV disease (WHO III or IV) at enrolment (AHR=2.2, 95% CI: 1.2 to 3.9), and initiation of zidovudine+lamivudine or other cART backbones (unadjusted HR (UHR)=2, 95% CI: 1.2 to 3.2). In contrast, a reduced likelihood of attrition was observed in children with a record of cART changes (UHR=0.2, 95% CI: 0.15 to 0.4).ConclusionA low incidence of attrition was observed in this study. However, the high mortality rate in the first 24 months of treatment and late presentation are concerning. Therefore, data-driven interventions for improving programme quality and outcomes should be prioritised.

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Section: Discussionmentioning

confidence: 99%

Attrition and associated factors among children living with HIV at a tertiary hospital in Eritrea: a retrospective cohort analysis

Mengistu

Ghebremeskel

Rezene

et al. 2022

bmjpo

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“…Twenty-two studies were included to estimate the pooled incidence of LTFU among HIV-positive children on ART in Ethiopia [ 13 , 14 , 16 – 21 , 27 – 32 , 34 – 41 ]. Accordingly, the pooled incidence of LTFU among HIV-positive children on ART in Ethiopia was 2.79 (95% CI: 1.99, 3.91) per 100-child-year observations using a random effect model.…”

Section: Resultsmentioning

confidence: 99%

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: Children on ART who were lost to follow-up or died within the follow-up time. 14 , 15 , 24 Loss to follow-up: Children who have not come for care for three or more consecutive months (≥90 days) after the last missed appointment and are not registered dead or transferred to other health facilities. 14 , 26 Mortality: Children registered as “died” at the exit form of patient.…”

Section: Methodsmentioning

confidence: 99%

“… 14 , 15 , 24 Loss to follow-up: Children who have not come for care for three or more consecutive months (≥90 days) after the last missed appointment and are not registered dead or transferred to other health facilities. 14 , 26 Mortality: Children registered as “died” at the exit form of patient. 16 CD4 count for severe immunodeficiency: The classification was based on children’s age.…”

Section: Methodsmentioning

confidence: 99%

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Proportion of Attrition and Associated Factors Among Children Receiving Antiretroviral Therapy in Public Health Facilities, Southern Ethiopia

Guyo,

Toma,

Haftu

et al. 2023

HIV

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Purpose Acquired immunodeficiency syndrome (AIDS) is a major global public health concern. Despite the improved access and utilization of antiretroviral therapy (ART), attrition from care among children continues to be a major obstacle to the effectiveness of ART programs. Hence, this study aimed to assess the proportion of attrition and associated factors among children receiving ART in public health facilities of Gamo and South Omo Zones, Southern Ethiopia. Patients and Methods A retrospective follow-up study was conducted in public health facilities of Gamo and South Omo Zones in Southern Ethiopia from April 12, 2022, to May 10, 2022. The proportion of attrition was determined by dividing the number of attrition by the total number of participants. Descriptive statistics were calculated. A binary logistic regression model was used to identify factors associated with attrition. Statistical significance was set at p-value <0.05. Results The median age of the participants was 5.5 (IQR: 2–9) years. The proportion of attrition from ART care was 32.4% (95% confidence interval (CI): 27.57% to 37.69%). Death of either of the parents (adjusted odds ratio (AOR) = 2.19; 95% CI:1.14, 4.18), or both parents (AOR = 3.19; 95% CI: 1.20, 8.52), hemoglobin level <10mg/dL (AOR = 2.39, 95% CI: 1.21, 4.70), a cluster of differentiation (CD)4 count ≤200 cells/mm 3 (AOR = 6.78, 95% CI: 3.16, 14.53), CD4 count 200–350 cells/mm 3 (AOR = 2.65, 95% CI: 1.16, 6.03), suboptimal adherence (AOR = 6.38; 95% CI: 3.36, 12.19), and unchanged initial regimen (AOR = 6.88; 95% CI: 3.58, 13.19) were factors associated with attrition. Conclusion Attrition from care is identified to be a substantial public health problem. Therefore, designing interventions to improve the timely tracing of missed follow-up schedules and adherence support is needed, especially for children with either/both parents died, unchanged initial regimen, low CD4, and/or low hemoglobin level.

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Incidence and predictors of attrition among children attending antiretroviral follow-up in public hospitals, Southern Ethiopia, 2020: a retrospective study

Cited by 6 publications

References 29 publications

Attrition and associated factors among children living with HIV at a tertiary hospital in Eritrea: a retrospective cohort analysis

Attrition and associated factors among children living with HIV at a tertiary hospital in Eritrea: a retrospective cohort analysis

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

Proportion of Attrition and Associated Factors Among Children Receiving Antiretroviral Therapy in Public Health Facilities, Southern Ethiopia

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