Death and Transferred Out as Competing Event for Lost to Follow-up among HIV-positive Adults on ART, in Eastern Ethiopia Governmental Hospitals from January 2015 to December 2021; (Multicenter Competing Risk Regression Analysis)

Abstract

Background: Lost to follow-up (LTFU) among patients on antiretroviral therapy accounts for the most of all attrition. In Sub-Saharan Africa,there is a concern regarding high rates of LTFU and early mortality in antiretroviral therapy programs. Mortality and transferred out are the potential competing events for LTFU. Ignoring these events may give an invalid estimate by overestimating the probability of the occurrence of LTFU. Objective: This study aims to assess the incidence and predictors of LTFU among adult HIV (Human Immunodeficiency Virus) patients who started antiretroviral therapy (ART) in Jigjiga Governmental Hospitals’ ART clinics between January 2015 and December 2021. Methods: A multi-center Institution-based retrospective follow-up study has been conducted in Jigjiga Governmental Hospitals. Gray’s test was used to compare the cumulative incidence function (CIF) of LTFU across variable categories. A graphical examination of CIF for each category of variables, as well as the Schoenfeld residuals global test, validate the proportional sub-hazard assumption. We fitted both univariable and multivariable competing risk regression models. In the multivariable analysis, variables with p-values of 0.05 were considered statistically significant predictors of LTFU. Result: A total of 842 clients were included in the study, and the LTFU incidence rate is 5.25 per 100 PYO. The participants’ median age ranged from 29 to 43 years. Those not disclosed their HIV status (aSHR=4.22; 95%CI (2.11-8.47)), those were a fair and poor level of recent adherence (aSHR=2.17; 95%CI (1.18-4.23)) and (aSHR=1.48; 95%CI (2.97-5.34)), patients with severe anemia (aSHR 4.58; 95% CI (1.28-16.39)) ambulatory functional status (aSHR 2.38; 95% CI (1.21-4.68)), patients who do not took cotrimoxazole prophylactic therapy (CPT) (aSHR 2.47; 95% CI (2.99-6.15)) were significant predictors of LTFU. Conclusion: In this study, the incidence of LTFU was decreased with additional years on ART. Patients on ART who did not disclose their HIV status had poor levels of adherence, did not take CPT prophylaxis, on severe anemia and ambulatory functional status were at higher risk of LTFU. As a result, close monitoring and proper tracing mechanisms aimed at this higher-risk group would reduce AIDS (Acquired immunodeficiency syndrome)-related LTFU.