Revista de SIDA e investigación clínica

Incidence and Determinants of Attrition among HIV Infected Patients Receiving Antiretroviral Therapy in Dessie Referral Hospital, Ethiopia: Retrospective Follow up Study

Abstract

Girum Shibeshi Argaw1, Aynishet Adane Mariyam2, Adhanom Gebreegziabher Baraki3 and Tilahun Yemanu Birhan3*

Background: Antiretroviral treatment (ART) scale-up has resulted in significant reductions in HIV-related morbidity and death. However, attrition from ART care remains a major public health concern, and it has been highlighted as one of the most important reportable factors in evaluating the success of ART programs. However, there are few researches in the subject region that indicate the incidence and predictors of it. As a result, the goal of this study was to determine the rate of attrition and predictors of attrition among adult HIV patients who started antiretroviral therapy (ART) at Dessie Referral Hospital.

Method: An Institution-based retrospective follow up study was conducted from January 2015 to October 2019. A sample of 565 patients was selected using simple random sampling and we were use data extraction checklist for extracting data from patient charts. The proportional hazard assumption was verified visually and using the Schoenfeld residual global test; a bi-variable cox regression analysis was performed. In the bivariable study, variables having a p-value of 0.2 were fitted to the multivariable cox regression analysis.

Result: A total of 565 adult HIV patients on ART were included in the analysis, The Incidence rate of over all attrition in this study was 14.2 per 100 person-year (95% CI; 12.2-16.6). Having ambulatory functional status, (aHR=2.08; 95% CI (1.29-3.33)), a patient who did not disclosed their HIV status (aHR=2.27; 95%CI; 1.39-3.69), presence of Comorbidity throughout the follow-up time 2.11 (aHR-2.11;95%CI (1.38-3.23)), patients who didn’t take CPT prophylaxis 1.68 (aHR-1.68;95%CI (1.34-2.49)),fair and poor level of adherence 2.75 (aHR=2.75; 95%CI (1.75-4.30)) and 2.16 (aHR=2.16; 95%CI (1.39-3.36)) respectively were significant predictors of attrition.

Conclusion: In this study, the incidence of attrition was high. Patients on ART who did not disclose their HIV status, those who were in fair and poor level of adherence, those did not take CPT prophylaxis,, ambulatory functional status, patients who had co morbidity at enrollment, were at higher risk of Attrition. Therefore, intensive monitoring, reminders, surveillance, and tracking mechanisms aimed at this higher-risk population would reduce ART attrition.