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

Abstract

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.

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

“… 13 Differences in the sociodemographic characteristics of the study participants may be another reason. The results of this study are in line with those of studies conducted in Northwest Ethiopia (30.5%) 16 and Gedeo, Southern Ethiopia (36.2%). 14 This consistency may be due to the similarity in data-recording formats and follow-up charts in Ethiopia’s ART program.…”

“…27 In addition, this may be due to the similarity in the measurements of LTFU. 14 , 16 In contrast, the findings of this study are higher than those of studies conducted in low and middle-income countries, 8 22%; Myanmar Asia, 6 14%; Mingalardon in Myanmar, 11 9.7%); and Southwest China, 25 (18.1%). It is also higher than that reported in studies conducted in Eritrea 28 (24.2%), the Oromia region, and Addis Ababa 15 (7.9%).…”

“…The sample size was determined using a single population proportion formula [ ] by considering a 95% confidence interval with a confidence level of Z a/2 = 1.96, the proportion of attrition (P) of 30.5% taken from a study done in Northwest Ethiopia, 16 and 5% margin of error (d). The previous study was selected for sample size calculation due to the similarity of the study topic, it’s being a recent study, and the fact that it was done in a similar setup (country) as the current study.…”

“… 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. For children <5 years CD4 <200 cells/mm 3 , and CD4 <100 cells/mm 3 in children ≥5 years.…”

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

“…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.…”