Incidence and predictors of loss to follow-up among human immunodeficiency virus-infected adult patients on anti-retroviral therapy at Hadiya zone public hospitals, southern Ethiopia: a retrospective cohort study

Abstract

Loss to follow-up from anti-retroviral therapy (ART) is common and can have adverse health impacts. This study aimed to assess the incidence and predictors of loss to follow-up among adult patients on ART treatment at Hadiya zone public hospitals. An institution-based retrospective cohort study was conducted in public hospitals in Hadiya zone, Ethiopia, from 2014 to 2018. Kaplan-Meier failure curves were used to estimate the probability of loss to follow-up after ART initiation. The Cox proportional hazard model was used to assess predictors associated with loss to follow-up after ART initiation. The incidence rate of loss to follow-up among advanced and not advanced disease of adult HIV-infected patients was 11.9/100 person-years (95% CI 9.47–14.99) and 8.6/100 person-years (95% CI 6.37–11.67), respectively. Baseline CD4 cell count < 200 cells/mm³ (AHR = 3.4, 95% CI: 1.87, 6.18), advanced disease at ART initiation (AHR = 0.33, 95% CI: 0.18, 0.58), not receiving isoniazid preventive therapy (AHR = 2.5, 95% CI: 1.64, 3.94), fair or poor adherence to medication (AHR = 2.8, 95% CI: 1.87, 4.34) and ambulatory or bedridden functional status (AHR = 2.4, 95% CI: 1.33, 4.18) were significantly associated. The overall incidence rate of loss to follow-up was high. Loss to follow-up was associated with low CD4 cell count, advanced disease stage, not receiving IPT, fair or poor adherence and ambulatory or bedridden functional status. Therefore, interventions should be strengthened to reduce loss to follow-up by addressing the identified risk factors.