Loss to follow-up in “test and treat era” and its predictors among HIV-positive adults receiving ART in Northwest Ethiopia: Institution-based cohort study

Abstract

BackgroundPeople living with HIV/AIDS are enrolled in lifelong Anti-Retroviral Treatment (ART) irrespective of their clinical staging as well as CD4 cell count. Although this “Universal Test and Treat” strategy of ART was found to have numerous benefits, loss from follow-up and poor retention remained a long-term challenge for the achievement of ART program targets. Hence, this study is aimed at addressing the much-needed effect of the test and treat strategy on the incidence of loss to follow-up (LTFU) in Ethiopia.Method and materialsAn institution-based follow-up study was conducted on 513 adults (age ≥15) who enrolled in ART at a public health institution in Bahir Dar City, Northwest Ethiopia. Data were extracted from the charts of selected patients and exported to Stata 14.2 software for analysis. Basic socio-demographic, epidemiological, and clinical characteristics were described. The Kaplan–Meier curve was used to estimate the loss to follow-up free (survival) probability of HIV-positive adults at 6, 12, 24, and 48 months of ART therapy. We fitted a multivariable Cox model to determine the statistically significant predictors of LTFU.ResultThe incidence density of LTFU was 9.7 per 100 person-years of observation (95% CI: 7.9–11.9 per 100 PYO). Overall, LTFU is higher in the rapid ART initiation (24% in rapid initiated vs. 11.3% in lately initiated, AHR 2.08, P = 0.004), in males (23% males vs. 14.7% females, AHR1.96, P = 0.004), in singles (34% single vs. 11% married, with AHR1.83, P = 0.044), in non-disclosed HIV-status (33% non-disclosed 11% disclosed, AHR 2.00 p = 0.001). Patients with poor/fair ART adherence were also identified as another risk group of LTFU (37% in poor vs. 10.5% in good adherence group, AHR 4.35, P = 0.001).ConclusionThe incidence of LTFU in this universal test and treat era was high, and the highest figure was observed in the first 6 months. Immediate initiation of ART in a universal test and treat strategy shall be implemented cautiously to improve patient retention and due attention shall be given to those high-risk patients.

Incidence and predictors of loss to follow-up among adult patients receiving antiretroviral therapy in Central Ethiopia: a multi-center retrospective cohort study

“…The incidence rate in this study was consistent with studies conducted in Gondar, Ethiopia (10.90 per 100-person years) ( 17 ), Bahir Dar City, Northwest Ethiopia (9.7 per 100 person-years of observation) ( 18 ), Debre birhan, Northeast Ethiopia (8.9 per 100 adult years observation) ( 19 ), Gonder, Ethiopia (6.7 per 100 person-years) ( 20 ) and Cameroon (9.46 per 100 person-years) ( 21 ). On the other hand, this finding was lower compared to a study conducted in other African countries: Uganda (21 per 1,000 person-months) ( 22 ), Malawi (26.0 per 100 person-years) ( 23 ), Pawi, and Northwest Ethiopia (11.6 per 100-person-years) ( 24 ).…”

Predictors of loss to follow up among adults on antiretroviral therapy before and after the start of treat-all strategy in public health facilities of Hawassa city, Ethiopia: A Competing risk regression

“…The incidence of LTFU was 8.67 per 100 person-years in the treat-all period was consistent with 8.9 per 100 person-year reported from North Shewa zone, public hospitals [44]. However, it was lower than the previous studies conducted at Felege Hiwot Comprehensive Specialized Hospital, Northwest Ethiopia [45] and Burundi [46]. The differences might be due to the differences in baseline clinical, the occurrence of opportunistic infection, and nutritional characteristics of the patients, as low immunological status was a key criterion for treatment initiation in the pre-treat-all era, impacting care retention.…”

HIV test-and-treat policy improves clinical outcomes in Zambian adults from Southern Province: a multicenter retrospective cohort study

“…Multivariable logistic regression was used to examine the factors associated with retention using generalized estimating equations (GEE) via the logit link function to account for correlation structure within observations. The variables [cohort (ATT), age, sex, facility location, marital status, duration to ART initiation after HIV diagnosis, WHO stage, ART regimen, and BMI] in the adjusted analysis were selected based on previous literature ( 19 , 26 , 31 , 32 ) and knowledge from HIV treatment and management experts. To ascertain statistical significance, a p value of <0.05 was used.…”

“…Persons who disengage from care and stop taking medication have a high probability of transmitting HIV infection, attaining AIDS status, and dying ( 30 ). The drivers of retention in care include female sex, older age, disclosure of HIV status, optimal ART adherence, viral suppression, a high CD4 count, and delayed ART initiation after HIV diagnosis ( 19 , 26 , 31 , 32 ). Being divorced and in a relationship, acquiring HIV infection perinatally, and voluntary testing and counseling are some of the drivers of retention ( 33–35 ) in our setting.…”