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

Nurilign Abebe Moges,Yemane Berhane,Okunlola Micheal,Adesina Olubukola

doi:10.1186/s12879-020-05168-3

Abstract

BackgroundThere is paucity of evidence on the magnitude of HIV patients’ retention and attrition in Ethiopia. Hence, the aim of this study was to determine the pooled magnitude of HIV patient clinical retention and attrition and to identify factors associated with retention and attrition in Ethiopia.MethodsSystematic review and meta-analysis were done among studies conducted in Ethiopia using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guideline. Both published and unpublished studies conducted from January 1, 2005 to June 6th, 2019 were included. Major databases and search engines such as Google Scholar, PUBMED, African Journals Online (AJOL) and unpublished sources were searched to retrieve relevant articles. Data were assessed for quality, heterogeneity and publication bias. Analysis was conducted using STATA version 14 software.ResultFrom a total of 45 studies 546,250 study participants were included in this review. The pooled magnitude of retention in care among HIV patients was 70.65% (95% CI, 68.19, 73.11). The overall magnitude of loss to follow up 15.17% (95% CI, 11.86, 18.47), transfer out 11.17% (95% CI, 7.12, 15.21) and death rate were 6.75% (95% CI, 6.22, 7.27). Major determinants of attrition were being unmarried patient (OR 1.52, 95% CI: 1.15–2.01), non-disclosed HIV status (OR 6.36, 95% CI: 3.58–11.29), poor drug adherence (OR 6.60, 95% CI: 1.41–30.97), poor functional status (OR 2.11, 95% CI: 1.33–3.34), being underweight (OR 2.21, 95% CI: 1.45–3.39) and advanced clinical stage (OR 1.85, 95% CI: 1.36–2.51). Whereas absence of opportunistic infections (OR 0.52, 95% CI: 0.30–0.9), normal hemoglobin status (OR 0.29, 95% CI: 0.20–0.42) and non-substance use (OR 95% CI: 0.41, 0.17–0.98) were facilitators of HIV patient retention in clinical care.ConclusionThe level of retention to the care among HIV patients was low in Ethiopia. Socio-economic, clinical, nutritional and behavioral, intervention is necessary to achieve adequate patient retention in clinical care.

Highlights

There is paucity of evidence on the magnitude of Human Immunodeficiency Virus (HIV) patients’ retention and attrition in Ethiopia
Partner testing, HIV status disclosure and mutual support are important components of HIV intervention [3, 84]. In contrast to these findings, one study in Nigeria showed that married women were poor in Conclusion About two third of HIV patients were retained in care
It can be concluded that Ethiopia has long to walk to achieve the minimum targets of patient retention achieved by most of low income countries

Summary

Introduction

There is paucity of evidence on the magnitude of HIV patients’ retention and attrition in Ethiopia. The aim of this study was to determine the pooled magnitude of HIV patient clinical retention and attrition and to identify factors associated with retention and attrition in Ethiopia. 36.7 million people were living with Human Immunodeficiency Virus (HIV) in 2016 [1]. A record 19.5 million people were accessing antiretroviral therapy in 2017, and for the first time, more than half of all people living with HIV are on treatment [2]. The treatment coverage of all HIV positive people was 59% and only 51% of all HIV positive people on highly active antiretroviral therapy (HAART) had viral suppression [1]. In 2017, an estimated 738,976 Ethiopians were living with HIV and all of them were eligible for ART treatment. It was reported that only 426,000 were taking ARV in the same year [3]

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