Predictors of loss to follow-up in patients living with HIV/AIDS after initiation of antiretroviral therapy in Benshangul Gumuz Regional State, Western Ethiopia Predictors of loss to follow-up in patients living with HIV/AIDS after initiation of antiretroviral therapy Section MEDICAL SCIENCE

Abstract

Background: Long-term regular follow up of ART is an important component of HIV care. Patients who are lost to follow-up (LTFU) while on treatment compromise their own health and the long-term success of ART programs

Objective: To assess prevalence and risk factors for LTFU in HIV patients on ART at ART clinic of Benshangul Gumuz, Ethiopia

Methods: A retrospective cohort study design was conducted among a minimum 1044 of people living with HIV/AIDS and attending an ART clinic in ten health care facilities of Benshangul Gumuz region between 2005 and 2014. The primary outcome variable was LTFU from ART follow-up care after initiation of treatment, confirmed by reviewing medical registration at the facility. The time to LTFU calculated in year’s base according to the time interval between the dates of ART initiation to the date of termination, as recorded by the ART registration book. A logistic regression model was employed in order to identify independents predictors to Lost to follow up (LTFU).

Result: One thousand forty-four patients living with HIV, who were start ARV treatment, were reviewed their documents for this study. Three quarter (76.1%) of the clients had working functional at ART initiation for the adult. However, for children whose age less or equal to 15 years old: 54(43.9%) of the clients had appropriate developmental milestones at ART initiation. Nearly two-thirds (66%) of the study participants started ART at an advanced stage of WHO clinical stage III and 190(18.2%) of the clients started ART at WHO stage II followed by 97(9.3%) of the clients were initiate ART at WHO stage IV at the baseline of ART start. Majority 63.1% of the study subject was done TB screening among them 110(10.5%) of the clients were positive in the TB screening result where 549 (52.6%) of the clients were negative TB screening result. Regarding CD4 count, 248 (25.9%) of the clients were start ARV treatment, when their CD4 count were below or equal to 100 cells/mm3  and 282 (29.4%) of the client, was start ARV treatment when their CD4 count was 100 – 200 cell/mm3 which is below the threshold for severe immunodeficiency. From the study subject in this cohort analysis; the outcome of patients after ARV treatment initiative 883(84.6%) of the clients were active, 82(7.9%) of the clients died, 14 (1.3%) of the clients were lost (lost from the treatment for less than three months) and 65(6.2%) of the clients were drop (lost from the treatment for 3months and more). The main reasons for termination of ARV treatment were toxicity/side effect of the drug 10 (7.0%), far distance 13 (9.2%), forget 8 (5.6%), too ill/sick 29 (20.4%) and deceased 82 (57.7%). After initiating ART drug there is an increment of CD4 count, which range from the mean number of CD4 count 216.73cell/mm3 to the mean number of CD4 count 609.89cell/mm3 after the 8-years treatment of ART. The socio-demographic predictors for lost to follow up were place of the residents being rural [AOR = 2.42, 95% CI: 1.64, 3.58] and marital status being married [AOR = 2.03, 95%CI: 1.04, 3.96] and being divorced [AOR = 2.94, 95% CI 1.96, 4.43] showed significant association on multivariate analysis. Furthermore, those patients whose CD4 cell count lied between 201–350 were 62% less likely to lost to follow up ART services as compared to those patients whose CD4 count was less than 100 cells per milliliter [AOR= 0.38; 95% CI 0.19–0.73].  Bedridden functional status of patients at the baseline of the utilization of the services was 6.28times more likely to become lost to follow up ART services compared with those patients who are working functional status of the patients at the baseline of the utilization of the services [AOR = 6.28; 95% CI: 2.85 – 13.97].

Conclusion and recommendation: The major determinate predictors identified for lost to follow up (LTFU) ART after staring ARV treatment were the place of residence, marital status, CD4 count and bedridden at the baseline of the treatment. So, increase the accessibility of ART programs and early initiation of ART while CD4 counts are higher and opportunistic infections limited, provision of early detection of TB and initiate Anti-TB drug by prescription initiative, and counseling of patients for early presentation during testing for HIV is recommended.