临床传染病与实践

抽象的

Loss to Follow Up from Anti-Retroviral Therapy and Factors Associated among HIV/AIDS Patients at Dubti Referral Hospital, Northeast Ethiopia

Kebena Eliyas, Girmatsion Fisseha, Dawit Zenebe, Alefech Addisu

Background: Sub-Saharan Africa contributed 76% of the total HIV-infected people, 76% of the total new HIV infections, and 75% of the total HIV/AIDS deaths in 2015. Loss to follow up from ART treatment is one of the reasons for ineffectiveness in developing countries. Therefore, this study aimed to assess the incidence and determinant of loss to follow up among adult clients on ART at Dubti teaching and referral hospital.

Methods: Retrospective cohort study design was conducted among 390 adult people living with HIV/AIDS attending ART clinic between September 1, 2013 and September 1, 2018 at Dubti Hospital, Ethiopia. Patients were selected using systematic random sampling after considering all patients medical charts during the 2013 and 2018 to include in this study. Data were collected using medical document review from the baseline to follow-up treatments using structured checklist. Data were analyzed using STATA version 14. Kaplan-Meier curve was used to estimate the time to loss to follow up. Both bivariate and multivariate Cox proportional hazards models were used to identify predictors of loss to follow up. The goodness of fit of the final model was checked by both Sheffield residual statistical test and Harrell's C concordance statistics.

Results: Total person month contributed by the study participant was 8,589 (715.5 person month). The incidence of lost to follow up was 9.7(95% CI 7.6, 12) per 100 person years and median survival time was 10 months. Patient on monthly based ART program were found more likely to loss from follow up than that of on ART patient on spacing type program (AHR: 6.66, 95% CI, 3.32, 13.4). Patient with CD4 ≥400 were found more likely lost to follow up than those with CD4 between 50 and 200 (AHR: 1.3, 95% CI, 0.35, and 8.48).

Conclusions: This study revealed as incidence of lost from follow up is high in comparable with world health organization strategic plan which called 90-90-90. Shorter Type of ART program or schedule, adherence to ART, and higher CD4 level WHO stage were the factors associated with lost to follow-up. Defaulter tracing mechanism should be operational and strengthen in the health facility.