Loss to follow-up in "test and treat era" and its predictors among HIV-positive adults receiving ART in Northwest Ethiopia: Institution-based cohort study

Berihun Bantie; Awole Seid; Gashaw Kerebeh; Animut Alebel; Getenet Dessie

doi:10.3389/fpubh.2022.876430

Loss to follow-up in "test and treat era" and its predictors among HIV-positive adults receiving ART in Northwest Ethiopia: Institution-based cohort study

Front Public Health. 2022 Sep 29:10:876430. doi: 10.3389/fpubh.2022.876430. eCollection 2022.

Authors

Berihun Bantie¹, Awole Seid², Gashaw Kerebeh³, Animut Alebel⁴, Getenet Dessie²

Affiliations

¹ Department of Adult Health Nursing, College of Medicine and Health Science, Debre Tabor University, Debre Tabor, Ethiopia.
² Department of Adult Health Nursing, School of Health Science, College of Medicine and Health Science, Bahir Dar University, Bahir Dar, Ethiopia.
³ Department of Pediatrics and Child Health Nursing, College of Medicine and Health Science, Debre Tabor University, Debre Tabor, Ethiopia.
⁴ School of Public Health, Faculty of Health, University of Technology Sydney, Ultimo, NSW, Australia.

Abstract

Background: People living with HIV/AIDS are enrolled in lifelong Anti-Retroviral Treatment (ART) irrespective of their clinical staging as well as CD4 cell count. Although this "Universal Test and Treat" strategy of ART was found to have numerous benefits, loss from follow-up and poor retention remained a long-term challenge for the achievement of ART program targets. Hence, this study is aimed at addressing the much-needed effect of the test and treat strategy on the incidence of loss to follow-up (LTFU) in Ethiopia.

Method and materials: An institution-based follow-up study was conducted on 513 adults (age ≥15) who enrolled in ART at a public health institution in Bahir Dar City, Northwest Ethiopia. Data were extracted from the charts of selected patients and exported to Stata 14.2 software for analysis. Basic socio-demographic, epidemiological, and clinical characteristics were described. The Kaplan-Meier curve was used to estimate the loss to follow-up free (survival) probability of HIV-positive adults at 6, 12, 24, and 48 months of ART therapy. We fitted a multivariable Cox model to determine the statistically significant predictors of LTFU.

Result: The incidence density of LTFU was 9.7 per 100 person-years of observation (95% CI: 7.9-11.9 per 100 PYO). Overall, LTFU is higher in the rapid ART initiation (24% in rapid initiated vs. 11.3% in lately initiated, AHR 2.08, P = 0.004), in males (23% males vs. 14.7% females, AHR1.96, P = 0.004), in singles (34% single vs. 11% married, with AHR1.83, P = 0.044), in non-disclosed HIV-status (33% non-disclosed 11% disclosed, AHR 2.00 p = 0.001). Patients with poor/fair ART adherence were also identified as another risk group of LTFU (37% in poor vs. 10.5% in good adherence group, AHR 4.35, P = 0.001).

Conclusion: The incidence of LTFU in this universal test and treat era was high, and the highest figure was observed in the first 6 months. Immediate initiation of ART in a universal test and treat strategy shall be implemented cautiously to improve patient retention and due attention shall be given to those high-risk patients.

Keywords: HIV positive adults; Northwest Ethiopia; loss to follow up; predictors; test and treat strategy.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Adult
Cohort Studies
Ethiopia / epidemiology
Female
Follow-Up Studies
HIV Infections* / diagnosis
HIV Infections* / drug therapy
HIV Infections* / epidemiology
Humans
Lost to Follow-Up*
Male
Retrospective Studies