Determinants of Loss to Follow-up among HIV-infected Adult Patients Enrolled in Antiretroviral Therapy in Tepi General Hospital, South west Ethiopia: A case control study

Abstract

Background: Retention in care and adherence to the treatment is key indicator of the HIV program effectiveness. HIV-infected patients who are lost to follow-up while on treatment compromise their own health and the long-term achievement of antiretroviral therapy (ART) plans. However, there is limited evidence on the determinants of lost to follow-up among HIV infected patients ART in the study area. Objective: Thus, this study was aimed to assess the determinants of loss to follow-up among HIV-infected patients on ART at ART clinic of Tepi General Hospital, South West Ethiopia. Method: Unmatched case control study was used among a total of 360 records of (120 cases and 240 controls) patients who were registered on antiretroviral therapy in Tepi General Hospital from January 1st, 2017 to December 30, 2019. Baseline patient records were extracted from electronic data base and registration books. Statistical Analysis was done using backward method and multivariable logistic regression model to identify the determinants of loss to follow up among patients on ART. Level of statistical significance was declared at p –value less than 0.05. Results: After controlling for possible confounders, the independent variables that increased lost to follow-up of patient were being male [AOR = 2.2, 95% CI: (1.27, 4.10)], being aged 15-24 years[AOR = 3.8, 95% CI (1.0, 14.5)],being rural resident [AOR = 2.2, 95% CI: (1.2, 3.9)],being single [AOR = 3.6, 95% CI: (1.9, 6.7)] ,baseline CD4count <500cells/ml[AOR = 4.2, 95% CI: (2.01, 8.5)] , not disclosing HIV status [AOR = 1.8, 95% CI: (1.0, 3.2)] having WHO clinical stage three [AOR = 3.4, 95% CI: (1.6, 7.3)] and lack of telephone contact [AOR = 1.9, 95% CI: (1.03, 3.6)]. Conclusion: The current study found that, being male, being single, being aged 15-24 years not disclosing HIV status, having baselineCD4 count<500cells/ml, being rural residents, having WHO clinical stage three and four and lacking telephone contact at start of follow-up were determinants of loss to follow-up from chronic HIV care. The findings of this study have implications for patient support and monitoring in ART programs such as reengaging those who have been lost to follow-up from ART. Clinicians working in ART care shall consider the identified risk factors while giving ART service. Tracking the lost patients to make the evidence more complete is recommended for future research