Incidence and predictors of loss to follow-up among adults receiving ART in Metekel Zone, Northwest Ethiopia: a retrospective cohort study.
TL;DR
The observed LTFU incidence rate among adults receiving ART in Metekel Zone was notably higher than documented in prior studies, and enhanced monitoring and support strategies should target patients with baseline tuberculosis infection, poor treatment adherence, underweight at baseline, and high viral load, particularly within the first year of treatment initiation.
Abstract
Background
Loss to follow-up (LTFU) remains a significant global public health challenge, particularly among patients receiving antiretroviral therapy (ART). There is paucity of information on incidence and predictors of LTFU in the Metekel zone, which limits the ability to monitor the effectiveness intervention.
Objective
To assess the incidence and identify the predictors of loss to follow-up among adult people living with HIV at public health facilities in the Metekel Zone, Northwest Ethiopia.
Methods
A retrospective cohort study was conducted among 540 people living with HIV who enrolled in ART from June 28, 2017, to June 27, 2022, in the Metekel Zone. The study was conducted in one public hospital and eight public health centers. Patient records were randomly selected and extracted using a structured checklist. The Kaplan-Meier curves were compared using the log-rank test, and the Cox proportional hazard model was used to identify the independent predictors of LTFU. The strength of the association was measured using adjusted hazard ratio (AHR) along with 95% confidence intervals (CIs).
Results
Among 540 participants, 304 (56.3%) were females and the mean (SD) age participants was 35.7(12.41) years. The overall LTFU incidence rate was 15.12 (95% CI: 12.9-17.6) per 100 person-years. Tuberculosis infection at baseline (AHR: 2.12 95% CI: 1.33 - 3.38), underweight at ART initiation (AHR: 5.36, 95% CI: 3.46-8.31), poor ART adherence (AHR: 2.14, 95% CI: (1.32 - 3.46), and most recent viral load > 1000 copies/mL (AHR: 2.71, 95% CI: 1.55 - 4.72) were identified significant predictors of LTFU.
Conclusion
The observed LTFU incidence rate among adults receiving ART in Metekel Zone was notably higher than documented in prior studies. Hence, enhanced monitoring and support strategies should target patients with baseline tuberculosis infection, poor treatment adherence, underweight at baseline, and high viral load, particularly within the first year of treatment initiation. In addition, effective strategies to improve patient retention in HIV care should be designed considering the identified risk factors.