Abstract
Background
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.
Methods
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.
Results
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.
Conclusions
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.
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Abbreviations
- ABC:
-
Abacavir
- AHR:
-
Adjusted hazard ratio
- ARV:
-
Antiretroviral
- ART:
-
Antiretroviral therapy
- AZT:
-
Zidovudine
- BMI:
-
Body mass index
- CD4:
-
Cluster for differentiation 4
- CPT:
-
Cotrimoxazole prophylaxis therapy
- CHR:
-
Crude hazard ratio
- EFV:
-
Efavirenz
- FHAPCO:
-
Federal HIV/AIDS Prevention and Control Office
- IHRERC:
-
Institutional Health Research Ethics Committee
- IQR:
-
Interquartile range
- INH:
-
Isoniazid
- IPT:
-
Isoniazid prophylaxis therapy
- LTFU:
-
Loss to follow-up
- LMICs:
-
Low- and middle-income countries
- 3TC:
-
Lamivudine
- NVP:
-
Nevirapine
- OIs:
-
Opportunistic infections
- SD:
-
Standard deviation
- D4t:
-
Stavudine
- TDF:
-
Tenofovir
- UNAIDS:
-
United Nations Program on HIV/AIDS
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Ethical approval was obtained from Haramaya University, College of Health and Medical Sciences institutional health research ethics review committee (HU-IHRERC). Permission obtained from the School of Graduate Studies was submitted to Hadiya zone health department to grant official permission. Personal identifications or medical record numbers and other specific addresses were not reviewed. The recorded data were not accessed by a third person, only the principal investigator, and were kept confidential.
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Appendix
Appendix
Overall probability of loss to follow-up for a retrospective cohort study done at Hadiya zone public hospitals from 2014 to 2018
Kaplan-Meier failure estimate of LTFU among HIV-infected adult patients on ART with and without advanced disease stage in Hadiya zone public hospitals, Southern Ethiopia, from 2014 to 2018
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Bikoro, B., Oljira, L., Gobena, T. et al. 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. J Public Health (Berl.) 30, 229–240 (2022). https://doi.org/10.1007/s10389-020-01268-1
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DOI: https://doi.org/10.1007/s10389-020-01268-1