Abstract
BackgroundLoss to follow-up (LTFU) is a major public health problem to antiretroviral therapy (ART) programs in sub-Saharan Africa. Failure to account for patients’ LTFU outcomes (self-transfers and restarts) can result in inaccurate reporting of retention in care. In Ethiopia, specifically in the Benishangule Gumuz region, high LTFU reported patients, who were not assessed for their outcomes, are identified as a gap. Therefore, our objective was to determine the outcomes (alive or dead) of patients lost to follow-up (LTFU) from ART and identify factors associated with successful tracing and mortality of these patients.ResultsThe proportion of successful tracing was 75.5% (249 of 330). Among the traced patients (n = 249), 22.9% were deceased, 47.8% were on ART, and 29.3% had discontinued treatment. However, the remaining untraceable patients were not locatable due to wrong addresses (53.1%), change of residence (29.6%), and/or lack of functional phone contact (17.3%). Some (32.9%) of the patients discontinued because of negative test results, others (21.9%) for spiritual reasons or side effects (28.8%), and the remaining (16.4%) for other reasons. Tracing using phone numbers (AOR = 2.97, 95% CI 1.57–5.59) and existing long-term follow-up period for ART (AOR = 2.13, 95% CI 1.17–3.88) were strong predictors of successful tracing while not receiving cotrimoxazole preventive therapy (CPT) (AOR = 2.59, 95% CI 1.22–5.39) is a predictor for mortality of patients post-LTFU.ConclusionART programs need to retain current contact information of patients or guardians/friends for tracing. Having phone contact numbers and prolonged lengths of compliance with ART are predictors of successful tracing, while lack of cotrimoxazole preventive therapy is a predictor of mortality. Early tracing of beginners (newly admitted recipients) and updating their detailed information at each follow-up visit is essential.
Highlights
Loss to follow-up (LTFU) is a major public health problem to antiretroviral therapy (ART) programs in sub-Saharan Africa
Retention in care and support are important measures of ART program effectiveness and critical in achieving the 90-90-90 targets (90% of people living with human immunodeficiency virus (PLHIV) know their status, 90% of People living with human immunodeficiency virus (PLHIV) who know their status are on treatment (ART), and 90% of PLHIV on treatment have attained viral suppression) [1,2,3]
There were 480 (27%) patients classified as LTFU from the pool of 1760 ART-initiated HIV-positive patients at Pawi hospital in the study period
Summary
Loss to follow-up (LTFU) is a major public health problem to antiretroviral therapy (ART) programs in sub-Saharan Africa. In Ethiopia, in the Benishangule Gumuz region, high LTFU reported patients, who were not assessed for their outcomes, are identified as a gap. Retention in care and support are important measures of ART program effectiveness and critical in achieving the 90-90-90 targets (90% of people living with human immunodeficiency virus (PLHIV) know their status, 90% of PLHIV who know their status are on treatment (ART), and 90% of PLHIV on treatment have attained viral suppression) [1,2,3]. Studies in Ethiopia indicated a high proportion of loss to follow-up (LTFU), ranging between 14.5% and 22.6% for ART [4,5,6,7,8].
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