Incidence and predictors of loss to follow-up among HIV-positive adults in northwest Ethiopia: a retrospective cohort study

Abstract

Background Despite the rapid expansion of antiretroviral therapy services, ‘loss to follow-up’ is a significant public health concern globally. Loss to follow-up of individuals from ART has a countless negative impact on the treatment outcomes. There is, however, limited information about the incidence and predictors of loss to follow-up in our study area. Thus, this study aimed to determine the incidence rate and predictors of loss to follow-up among adult HIV patients on ART. Methods A retrospective cohort study was undertaken using 484 HIV patients between January 30, 2008, and January 26, 2018, at Debre Markos Referral Hospital. All eligible HIV patients who fulfilled the inclusion criteria were included in this study. Data were entered into Epi-data Version 4.2 and analyzed using STATATM Version 14.0 software. The Nelson-Aalen cumulative hazard estimator was used to estimate the hazard rate of loss to follow-up, and the log-rank test was used to compare the survival curve between different categorical variables. Both bivariable and multivariable Cox-proportional hazard regression models were fitted to identify predictors of LTFU. Results Among a cohort of 484 HIV patients at Debre Markos Referral Hospital, 84 (17.36%) were loss their ART follow-up. The overall incidence rate of loss to follow-up was 3.7 (95% CI 3.0, 5.0) per 100 adult-years. The total LTFU free time of the participants was 2294.8 person-years. In multivariable Cox-regression analysis, WHO stage IV (AHR 2.8; 95% CI 1.2, 6.2), having no cell phone (AHR 1.9; 95% CI 1.1, 3.4), and rural residence (AHR 0.6; 95% CI 0.37, 0.99) were significant predictors of loss to follow-up. Conclusion The incidence of loss to ART follow-up in this study was low. Having no cell phone and WHO clinical stage IV were causative predictors, and rural residence was the only protective factor of loss to follow-up. Therefore, available intervention modalities should be strengthened to mitigate loss to follow-up by addressing the identified risk factors.

Predictors of Loss to Follow-Up among HIV-Infected Adults after Initiation of the First-Line Antiretroviral Therapy at Arba Minch General Hospital, Southern Ethiopia: A 5-Year Retrospective Cohort Study

“…In this study, 46 (9.1%) adult HIV patients experienced loss to follow-up and the overall incidence rate of loss to follow-up was 5.3 (95% CI: 3.9-7.1) per 100 person-years of observation (PYs). This finding is consistent with the study conducted in Debre Markos, Ethiopia, which reported 3.7 per 100 person-years [ 22 ].…”

“…This might be because patients from the rural area may face a problem of accessibility or distance from treatment centers, transport-related costs, low level of awareness on the benefit and risk related to the adherence of treatment, and social stigma related to a disease HIV/AIDS. In contrary to this finding, a study done in Debre Markos, Ethiopia, reported that the risk of LTFU among rural residents was reduced by 40% when compared with urban residents [ 22 ]. The possible reason given is that study were patients coming from rural areas preferred to have ART follow-up in the nearby hospitals; this is because rural residents are stable or permanent residents compared to urban residents and due to the scarcity of money; they may not use the self-referral system to other healthcare institutions when compared to urban residents [ 22 ].…”

“…In contrary to this finding, a study done in Debre Markos, Ethiopia, reported that the risk of LTFU among rural residents was reduced by 40% when compared with urban residents [ 22 ]. The possible reason given is that study were patients coming from rural areas preferred to have ART follow-up in the nearby hospitals; this is because rural residents are stable or permanent residents compared to urban residents and due to the scarcity of money; they may not use the self-referral system to other healthcare institutions when compared to urban residents [ 22 ].…”

“…Different studies revealed that LTFU from the ART service is associated with baseline sociodemographic factors and clinical and treatment-related factors. From the sociodemographic variables: young age [ 16 , 21 , 30 ], male sex [ 18 , 19 , 31 – 33 ], high educational status [ 30 , 34 ], single marital status [ 10 , 35 , 36 ], self-employed-occupational status [ 28 , 33 ], rural residence [ 22 , 33 ], not disclosing their status to any one [ 19 , 34 ], distance from health facility over 5 kilometers [ 10 , 11 ], not having a primary caregiver [ 11 , 37 ], were reported predictors. Furthermore, clinical-, treatment-, and behavioral-related factors like baseline CD4 count < 200 cells/ μ L [ 18 , 20 , 33 ], WHO clinical stages III and IV [ 21 , 22 , 33 ], taking AZT-3TC-NVP ART regimen at the start [ 16 , 38 ], having an opportunistic infection at enrolment [ 18 , 20 , 39 ], bed-ridden and ambulatory baseline functional status [ 18 , 20 , 40 ], not receiving cotrimoxazole and isoniazid preventive therapy at the start [ 16 , 20 ], low body mass index (BMI) (<18.5 kg/m 2 ) [ 20 ], high viral loads [ 17 ], suboptimal (fair/poor) adherence level [ 20 , 33 ], substance use [ 20 ], next appointment not recorded [ 19 ], and having a cell phone [ 22 ] were reported predictors.…”

Loss to follow‐up of patients in HIV care in Burundi: A retrospective cohort study

“…The median age at ART initiation was 34 years (interquartile range [26][27][28][29][30][31][32][33][34][35][36][37][38][39][40][41][42][43]. The female/male sex ratio was 2.19/1.…”