Time to attrition and associated factors among Adults enrolled to pre-art care in teppi district Hospital, sheka zone, south west ethiopia

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.