Attrition rate and its predictors among adults receiving anti-retroviral therapy following the implementation of the "Universal Test and Treat strategy" at public health institutions in Northern Ethiopia. A retrospective follow-up study

Berihun Bantie; Moges Wubneh Abate; Adane Birhanu Nigat; Tekalign Amera Birlie; Tadila Dires; Tigabu Minuye; Gashaw Kerebeh; Chalie Marew Tiruneh; Natnael Moges; Ermias Sisay Chanie; Dejen Getaneh Feleke; Animut Tilahun Mulu; Biruk Demssie; Tigabinesh Assfaw Fentie; Melsew Dagne Abate; Makda Abate; Awoel Seid Ali; Getenet Dessie

doi:10.1016/j.heliyon.2022.e11527

Attrition rate and its predictors among adults receiving anti-retroviral therapy following the implementation of the "Universal Test and Treat strategy" at public health institutions in Northern Ethiopia. A retrospective follow-up study

Heliyon. 2022 Nov 11;8(11):e11527. doi: 10.1016/j.heliyon.2022.e11527. eCollection 2022 Nov.

Authors

Berihun Bantie¹, Moges Wubneh Abate¹, Adane Birhanu Nigat¹, Tekalign Amera Birlie¹, Tadila Dires¹, Tigabu Minuye¹, Gashaw Kerebeh², Chalie Marew Tiruneh², Natnael Moges², Ermias Sisay Chanie², Dejen Getaneh Feleke², Animut Tilahun Mulu³, Biruk Demssie⁴, Tigabinesh Assfaw Fentie⁴, Melsew Dagne Abate⁵, Makda Abate⁶, Awoel Seid Ali⁷, Getenet Dessie⁶

Affiliations

¹ Department of Comprehensive Nursing, College of Health Science, Debre Tabor University, Ethiopia.
² Department of Pediatrics and Child Health, College of Health Science, Debre Tabor University, Ethiopia.
³ Department of Biomedical Science, College of Health Science, Debre Tabor University, Ethiopia.
⁴ Department of Social and Public Health, College of Health Science, Debre Tabor University, Ethiopia.
⁵ Department of Nursing, College of Health Science, Woldia University, Ethiopia.
⁶ Department of Nursing, College of Medicine and Health Science, Debre Birhan University, Ethiopia.
⁷ Department of Adult Health Nursing, School of Health Science, College of Medicine and Health Science, Bahir dar University, Ethiopia.

Abstract

Introduction: Since 2016, the Ethiopian Federal Ministry of Health has adopted a "Universal Test and Treat" strategy to treat human immunodeficiency virus (HIV)/acquired immune deficiency syndrome (AIDS). In this test and treat era, access to anti-retroviral therapy (ART) has been rapidly expanded. On the other hand, poor retention of patients on ART remains a serious concern for reaching ART program goals. Thus, this study is targeted at investigating the attrition rate and its predictors among HIV-positive adults following the implementation of the "test and treat" strategy in Ethiopia.

Methods: An institution-based retrospective follow-up study was conducted among 1048 HIV-positive adults receiving ART at public health institutions in Bahir Dar city, Northern Ethiopia. Data were extracted from randomly selected patient charts, entered into Epidata 4.6 and exported to Stata 14.2 for analysis. Kaplan-Meier curve was used to estimate individuals' attrition-free probability at each specific point in time. Both bivariable and multivariable cox regression models were fitted, and variables with a P-value of <0.05 in the multivariable model were considered as significant predictors of attrition.

Results: A total of 1020 (97.3%) study participants were included in the final analysis. The attrition rate of individuals was 15 per 100 person-years of observation (95% CI: 13.5-16.9 per 100 PYO). World Health organization (WHO) stage III/IV clinical diseases (Adjusted hazard ratio/AHR/1.75 (95% CI:1.24-2.48)), Not disclosing HIV-status (AHR 1.6 (95% CI: 1.24-2.05)), rapid initiation of ART (AHR 2.05 (95%CI:1.56-7.69)), No history of ART regime change (AHR2.03 (95% CI: 1.49-2.76)), "1J (TDF_3TC-DTG)" ART regimen (AHR 0.46 (95%CI: 2.18-3.65)), and Poor ART adherence (AHR2.82 (95%CI: 2.18-3.65)) were identified as significant predictors of attrition rate of HIV positive adults.

Conclusion: Following the implementation of the universal test and treat area, the attrition rate of adults living with (HIV) found to be high. Due attention shall be provided to those individuals who didn't disclose their status, were initiated into ART within seven days, had WHO stage III/IV clinical disease, had poor adherence history, had no regimen change, and are not on 1J (TDF_3TC-DTG) ART regimen type.

Keywords: Attrition rate; Northern Ethiopia; Predictors; Test and treat era.