Abstract:
Background: Pre-Antiretroviral care starts with patients testing positive for Human Immuno
Virus and continuing until the first antiretroviral drugs are dispensed. High pre-ART attrition is
signal of poor uptake of interventions. Historically, strategies to address attritions have focused
on the ART period, with greatest attention and resource prioritization but, that of Pre-ART
period attrition was over looked and given lesser attention.
Objectives: This retrospective study assessed time to attrition and associated factors among
adults enrolled to pre-ART care from September 1, 2010 to August 31, 2013 in Teppi District,
Hospital, Sheka Zone, South West Ethiopia
Methods: The study has examined data on all adult pre-ART patients who were enrolled in to
care during the year 2010-2013 at Teppi District Hospital. Cox proportional hazard model was
used to assess the association of predictor variables with attrition (mortality and loss to followup). Kaplan-Meier survival table was used for comparison of the pre-ART care attritions of
patients segregated by predictor variables at enrolment.
Results: Patients were followed for 337.6 person years from enrolment to pre-ART outcomes,
with an overall attrition of 216(33.13%) and the highest attritions, 194 (89.8%) and 203 (94%)
occurred within the 6 months and one year of follow-up period respectively. The median followup period was 8.9 (interquartile range, 4.57-13.23) months. The independent predictors of
attrition included not having been started with cotrimoxazole prophylaxis (AHR=1.51, 95%CI,
1.02-2.25), being positive for tuberculosis (AHR=2.16, 95%CI, 1.35-3.45), living in ≥10km from
the service provision area (AHR=1.44, 95%CI, 1.07-2.0) and undisclosed HIV status at all
(AHR=3.04). The risk of attrition for clients who did not start cotrimoxazole prophylaxis at preART care during enrolment was higher when compared to those who did (AHR=1.51). The
difference in attrition time between these two categories of patients was statistically significant.
Conclusion: Pre-ART attrition was highest with in the first year of pre-ART care follow up time
due to not having been started with cotrimoxazole prophylaxis, being positive for tuberculosis,
living in ≥10km and having no HIV status disclosure at all. Thus, close monitoring of pre- ART
patients and improving uptake of CPT prophylaxis during this period is highly recommended.
