Abstract
BackgroundDespite the rapid expansion of antiretroviral therapy services, ‘loss to follow-up’ is a significant public health concern globally. Loss to follow-up of individuals from ART has a countless negative impact on the treatment outcomes. There is, however, limited information about the incidence and predictors of loss to follow-up in our study area. Thus, this study aimed to determine the incidence rate and predictors of loss to follow-up among adult HIV patients on ART.MethodsA retrospective cohort study was undertaken using 484 HIV patients between January 30, 2008, and January 26, 2018, at Debre Markos Referral Hospital. All eligible HIV patients who fulfilled the inclusion criteria were included in this study. Data were entered into Epi-data Version 4.2 and analyzed using STATATM Version 14.0 software. The Nelson-Aalen cumulative hazard estimator was used to estimate the hazard rate of loss to follow-up, and the log-rank test was used to compare the survival curve between different categorical variables. Both bivariable and multivariable Cox-proportional hazard regression models were fitted to identify predictors of LTFU.ResultsAmong a cohort of 484 HIV patients at Debre Markos Referral Hospital, 84 (17.36%) were loss their ART follow-up. The overall incidence rate of loss to follow-up was 3.7 (95% CI 3.0, 5.0) per 100 adult-years. The total LTFU free time of the participants was 2294.8 person-years. In multivariable Cox-regression analysis, WHO stage IV (AHR 2.8; 95% CI 1.2, 6.2), having no cell phone (AHR 1.9; 95% CI 1.1, 3.4), and rural residence (AHR 0.6; 95% CI 0.37, 0.99) were significant predictors of loss to follow-up.ConclusionThe incidence of loss to ART follow-up in this study was low. Having no cell phone and WHO clinical stage IV were causative predictors, and rural residence was the only protective factor of loss to follow-up. Therefore, available intervention modalities should be strengthened to mitigate loss to follow-up by addressing the identified risk factors.
Highlights
Despite the rapid expansion of antiretroviral therapy services, ‘loss to follow-up’ is a significant public health concern globally
Rural residence, and World Health Organization (WHO) clinical stage IV were the predictors of loss to follow-up of Human immunodeficiency virus (HIV)-related morbidity, drug resistance, hospitalization, and the risk of transmitting drug-resistant strains and shortened the survival status of HIV patients [2, 20, 24]
Population All adult HIV patients initiated on antiretroviral therapy (ART) from January 30, 2008, to January 26, 2018, at Debre Markos Referral Hospital in the ART clinic were our source population
Summary
Despite the rapid expansion of antiretroviral therapy services, ‘loss to follow-up’ is a significant public health concern globally. This study aimed to determine the incidence rate and predictors of loss to follow-up among adult HIV patients on ART. The risk of HIV transmission from HIV patients who had good ART adherence with regular follow-up to their uninfected sexual partners was dimmed drastically by 96% [7]. Loss to follow-up (LTFU) is a significant cause for treatment failure and threatens the enhancement of HIV treatment outcomes among patients on ART [8]. At the end of 2014, LTFU was estimated to be 18.7% in Ethiopia, which affects ART effectiveness [9]. This indicates that the expected outcome of ART is achieved when the patients exhibit good adherence with regular follow-up [10]
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