Predictors of attrition from care at 2 years in a prospective cohort of HIV-infected adults in Tigray, Ethiopia

Abstract

IntroductionEthiopia has experienced rapid expansion of antiretroviral therapy (ART). However, as long-term retention in ART therapy is key for ART effectiveness, determinants of attrition need to be identified so appropriate interventions can be designed.MethodsWe used data from the ‘Cohort of African people Starting Antiretroviral therapy’ (CASA) project, a prospective study of a cohort of HIV-infected patients who started ART in seven health facilities (HFs). We analysed the data of patients who had started first-line ART between January 2013 and December 2014. The Kaplan–Meier method was used to estimate the probability of retention at different time points. The Cox proportional hazards model was used to identify factors associated with attrition.ResultsA total of 1198 patients were included in the study. Kaplan–Meier estimates of retention in care were 83.9%, 82.1% and 79.8% at 12, 18 and 24 months after starting ART, respectively. Attrition was mainly due to loss to follow-up, transferred-out patients and documented mortality. A multivariate Cox proportional hazard model showed that male sex, CD4 count <200 cells/µL and the type of HF were significantly associated with attrition.ConclusionsThe observed attrition differences according to gender suggest that separate interventions designed for women and men should be explored. Moreover, innovative strategies to increase HIV testing should be supported to avoid CD4 levels falling too low, a factor significantly associated with higher attrition in our study. Finally, specific studies to analyse the reasons for different levels of attrition among HFs are required.

Body and mind: retention in antiretroviral treatment care is improved by mental health training of care providers in Ethiopia

“…In the exposed group, attrition was mainly from verified death whereas LTFU was found to be the major cause for attrition in the unexposed group. The later was in agreement with the existing evidence [ 12 , 13 , 20 ]. Different studies indicated that in low resource setting with poor vital registration system like in Ethiopia, deaths, and causes of death are not reported.…”

“…The overall Kaplan-Meir estimates of retention show that the largest attrition occurred in the first year. The probability of retention in the unexposed group was comparable with other studies conducted in Ethiopia [ 12 , 13 ]. Retention in care in the exposed groups from the present study seem to be higher than other studies in a similar setting unexposed for mental health care [ 13 , 19 ].…”

“…In this study, we found that male gender has 20% higher attrition rate as compared with women. Some reports find no significant difference [ 12 ], but the majority of the existing evidence indicates that in ART women have better outcomes than men [ 13 , 21 , 22 ]. This could be due to several reasons, including different lifestyle between the two genders; males use more alcohol; and different coping thresholds.…”

“…Currently, high attrition rate, poor adherence to treatment regimen, and early mortality are prominent challenges of the HIV/AIDS program in the country. Recent studies in Ethiopia indicated attrition to be around 20% at 6 months of follow-up [ 12 , 13 ], which could foster poor treatment outcomes, emergence of drug resistance and potential transmission of drug-resistant virus strain.…”

HIV patients retention and attrition in care and their determinants in Ethiopia: a systematic review and meta-analysis

“…Most (32) of the designs of the primary articles was retrospective follow up [9,10,[16][17][18], five case control [8,[49][50][51][52], six prospective cohort study [37,[53][54][55][56][57][58] and two cross sectional survey designs [59,60]. Every region of Ethiopia was represented in the included studies.…”