Loss to Follow-up and Death Among Individuals With Newly Diagnosed Human Immunodeficiency Virus Receiving Dolutegravir-Based First-Line Antiretroviral Treatment in Eastern Ethiopia: Implications for 95% United Nations Targets

Abstract

Background Loss-to-follow-up (LTFU) and mortality are unfavorable outcomes of HIV treatment. This study aimed to identify the predictors of LTFU and mortality among individuals newly diagnosed with HIV receiving dolutegravir (DTG)-based first-line antiretroviral treatment (ART) in eastern Ethiopia. Methods A multisite prospective cohort study was carried out between October 2020 and July 2022. New cases who started ART were enrolled consecutively, and then followed for the next six months. A structured questionnaire and checklists were used to collect data. HIV viral load test was done using the Abbott RealTime HIV-1 assay. Bi-variable and multivariable logistic regression models were used to identify baseline factors associated with the outcomes. Results 235 newly diagnosed people with HIV (PWH) were enrolled; 16.6% (95% CI =12.3–21.9%) were lost to follow-up, and 5.9% (95% CI =3.5–9.8%) died within six months of follow-up. Baseline WHO clinical stage I (AOR =3.93, 95% CI: 1.34–11.57), low viral load (AOR =3.67, 95% CI: 1.09–12.36), and body weight (AOR =1.04, 95% CI: 1.01–1.07) were predictors of LTFU, whereas non-functional status (AOR =10.02, 95% CI: 1.9–51.3) was the only factor associated with death. Conclusion LTFU and death rates among patients with DTG were relatively high, accounting for roughly a quarter of the attrition of newly diagnosed PWH from ART care and services. Thus, targeted interventions are required to reduce LTFU and death among individuals with HIV on ART. Further investigation is necessary to evaluate the long-term effects of DTG-based regimens on LTFU and its impact on HIV mortality, and qualitative research, specifically tracing LTFU patients, is recommended.

Factors influencing patients on antiretroviral therapy loss to follow up: A qualitative analysis of healthcare workers perspective

“…Key informant interviews (KIIs) were used to explore the reasons for LTFU from ART. LTFU in this study was defined as patient (s) not being on ART for more than one month [ 14 ]. It is unknown if these patients passed away, moved their care elsewhere, or had LTFU for other reasons.…”

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“…The Asunafo South District is one of the six (6) administrative districts in the Ahafo Region of Ghana. According to the 2020 population and housing census, the district had a total population of 93,619 with a total number of children 0-11 months and women in reproductive age being 3,668 and 22,006 respectively [13].…”