INCIDENCE AND PREDICTORS OF LOSS TO FOLLOW-UP AMONG HIV INFECTED ADULT PATIENTS ON ART IN HADIYA ZONE PUBLIC HOSPITALS, SOUTHERN ETHIOPIA

Abstract

Background: Loss to follow-up from ART-treatment is more common and can result to adverse health impact. In sub-Saharan Africa, including Ethiopia once patients start ART, more than a quarter patients lost within three years. There is limited evidence on the incidence of loss to follow up and its predictors among HIV infected adult patients at antiretroviral therapy in the current study areas. Objective: To assess incidence and predictors of loss to follow-up among human immunodeficiency virusinfected adult patients after initiation of antiretroviral therapy, at Hadiya zone public hospitals, southern Ethiopia from 2014- 2018. Data were collected from March 1-25/ 2019. Methods: An institution based retrospective cohort study design was undertaken. Based on ART registration records of HIV infected adult patients were categorized into advanced and not advanced diseases stages. The data were collected from individual folder and database by using data extraction format for 255 exposed and 297 unexposed total study population. Four health workers from the ART clinic collected data. Descriptive statistics were done by using Chi-square test and T-test to compare categorical and continuous variables between the two groups, respectively. Kaplan-Meier failure curves were used to estimate the probability of loss to follow up after ART initiation. The Cox proportional hazard model was used to assess predictors associated with loss to follow up after ART initiation. Results: The incidence rate of loss to follow up among advanced and not advanced disease of adult HIV infected patients [11.9 per 100 person-years with 95%CI (9.47-14.99)] and [8.6 per 100 person years with 95% CI (6.37-11.67)] respectively. Baseline CD4 cell count < 200cells/mm3[(AHR=3.4, 95%CI: (1.87, 6.18)], advanced disease at ART initiation[(AHR= 0.33, 95%CI: (0.18, 0.58)], not receiving isoniazid preventive therapy [(AHR= 2.5, 95%CI: (1.64, 3.94)], fair or poor adherence to medication [(AHR= 2.8, 95%CI: (1.87, 4.34)] and ambulatory or bedridden functional status [(AHR= 2.4, 95% CI : (1.33, 4.18) were significantly associated with loss to follow up. People with worse status were loss to follow up Conclusions: The overall incidence rate of loss to follow up among adults was 10.5 per 100 person-years, which was found to be high incidence rate. The loss to follow up among adult HIV infected patients was associated with low CD4 cell count, advanced disease stage, not receiving IPT, fair or poor adherence and ambulatory or bedridden functional status. Therefore, strong interventions is needed to address factors associated with loss to follow up should be implemented for optimal result in patient care.