INCIDENCE AND PREDICTORS OF ATTRITION AMONG ADULTS RECEIVING FIRST LINE ANTI-RETROVIRAL THERAPY AT PUBLIC HEALTH FACILITY IN ADEA BERGA DISTRICT, OROMIA, ETHIOPIA

Abstract

Background: The current working the Joint United Nations Program on Acquired Immuno Deficiency Syndrome Spectrum estimate for People living with Human Immunodeficiency Syndrome is 665,723 in Ethiopia. As Ethiopia inches closer to attaining the 95-95-95 targets for treatment coverage and reaching epidemic control, however, attrition from anti- retro viral treatment is still one of key programmatic challenge. Moreover, little information is known about the incidence and predictors of attrition in anti-retro viral treatment services in Ethiopia particularly in Adea Berga district. Objective: This study aimed to assess the incidence of attrition rate and its predictors among adult HIV patients receiving anti retro viral treatment at Public Health Facility in Adea Berga/Enchini District. Method: A six year institution based retrospective cohort study was conducted (June 28, 2015 to June 27, 2021). Simple random sampling technique was used to recruit 540 study participants by using registration/card number of the clients enrolled. Data was extracted from anti retro viral treatment registration book (chart review). The extracted data is coded and entered into Epi Data and exported to Stata version 14.2 software for analysis. The predictors of attrition were identified using bivariable and multivariable Cox Proportional hazard models and adjusted hazard ratio (AHR) was calculated to estimate the magnitude of association. Variables with a p-value of less than 0.05 in bivariable were included in the multivariable analysis and p -value of 0.05 was used to declare statistically significance in multivariate analyses. Result: From the total 540 study participant, a total of 1662.33 person-years were observed with a median follow-up time of 3.16 years (IQR 0.083−6). One hundred fifty eight (29.26%) patients were discontinuing from follow up making the incidence rate of attrition 9.50 per 100 person years (95% CI: 8.13-11.11). Being WHO clinical stage III or IV(AHR=1.96, 95% CI, 1.33−2.89), non practice of Appointment spacing model(AHR=3.98, 95% CI, 1.97−8.03), poor or fair ART adherence level (AHR=6.47, 95% CI, 4.19−9.97), age groups (15-24) years (AHR=1.73, 95% CI, 1.05−2.83) and Others ART linkage points[index case testing, Tuberculosis clinic and referral from private/public health institutions](AHR=1.76, 95% CI, 1.06−2.93) were significantly and positively associated with patient attrition. Conclusion: The result of this study showed that the incidence of attrition among adults receiving antiretroviral therapy was high. Patient socio demographic, clinical and treatment related factors were significantly associated with patients on ART.