Attrition Rate And Predictors Among Adult Patients Receiving Antiretroviral Therapy In Adama Hospital Medical College, Central Ethiopia: A Retrospective Cohort Study Design, 2006 - 2017
Volume 3 - Issue 8, August 2019 Edition
[Download Full Paper]
Tamrat Endebu Gebre, Alemayehu Bekele
Antiretroviral-therapy, Attrition, Ethiopia, predictors
Introduction: Efforts are underway in Ethiopia to achieve the 90:90:90 treatment goals set by the UNAIDS. Patient attrition from the treatment is known that a major challenge to ensure long-term retention. Therefore, this study aimed to assess attrition and it’s predictors among adult patients receiving ART in Adama Hospital Medical College, Ethiopia, from 2006 to 2017. Methods: A retrospective cohort study design was used. Adult patients started ART from January 2006 to December 2017were followed up for 12 years. The statistical analysis was done by using SPSS version 21 statistical software. Descriptive analysis was used present frequencies and mean/median of variables. The Kaplan–Meier survival probability was used to estimate the probability of attrition at different time points. The multivariate Cox-proportional hazard model was used to identify predictors of attrition. Results: A total of 7990 patients were followed and observed for 52,934 person-years. At the end of the follow up period, 1016 attrition due to LTFU or death occurred with an annual incidence density [95% CIs] of 19.2% (18.0–20.4). Younger age, male gender, rural resident, not fully recorded patient address in the follow up form, lower CD4 count at baseline and WHO clinical stages III/IV at ART initiation were predictors of time to attrition. Conclusion: Considerable incidence of attrition from antiretroviral therapy was observed. Therefore, the hospital management and other concerned staffs should aggressively conduct the lost to follow up tracking measures. Beside that targeted interventions to the above predictors can reduce attrition from care and treatment.
. UNAID (2016) Global-AIDS-update 2016-unaids. http://www.unaids.org/sites/default/files/media_asset/global-AIDS-update-2016_en.pdf.
. World health organization (2016) Consolidated guidelines on the use of antiretroviral drugs for treating and preventing HIV infection/recommendations for a public health approach second edition. http://www.who.int/hiv/pub/arv/arv-2016/en/
. Ethiopia-CIA (2018). https://www.cia.gov/library/publications/the-world-factbook/geos/print_et.html.
. Federal HIV/AIDS Prevention and Control Office (2014) HIV/AIDS strategic plan 2015-2020 in an investment case approach, Addis Ababa (Ethiopia): Federal HIV/AIDS Prevention and Control Office. 63 p. https://hivhealthclearinghouse.unesco.org/library/documents/hivaids-strategic-plan-2015-2020-investment-case-approach.
. Ethiopia, Country/Regional Operational Plan (COP/ROP) (2017) Strategic Direction Summary. https://www.pepfar.gov/documents/organization/272012.pdf.
. The Federal Democratic Republic of Ethiopia Ministry of Health (2015) Health Sector Transformation Plan (HSTP) 2015/16 - 2019/20. https://www.globalfinancingfacility.org/.../Ethiopia-health-system-transformation-plan.p.
. Rosen S, Fox MP, Gill CJ (2007) Patient retention in antiretroviral therapy programs in sub-Saharan Africa: a systematic review. PLoS Med. 4(10), e298. https://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.0040298.
. May M, Boulle A, Phiri S, Messou E, Myer L, Wood R et al (2010) Prognosis of patients with HIV-1 infection starting antiretroviral therapy in sub-Saharan Africa: a collaborative analysis of scale-up programmes. Lancet; 376:449–57. DOI:10.1016/S0140-6736(10)60666-6
. Martin W. G. Brinkhof , Mar Pujades-Rodriguez, Matthias Egger (2009) Mortality of patients lost to follow-up in antiretroviral treatment programmes in resource-limited settings: Systematic review and meta-analysis. https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0005790
. Wubshet M, Berhane Y, Worku A, Kebede Y, Diro E (2012) High loss to followup and early mortality create substantial reduction in patient retention at antiretroviral treatment program in north-west Ethiopia. ISRN AIDS. 2012:721720.
. Ayele W, Mulugeta A, Desta A, Rabito FA (2015) Treatment outcomes and their determinants in HIV patients on Anti-retroviral Treatment Program in selected health facilities of Kembata and Hadiya zones, Southern Nations, Nationalities and Peoples Region, Ethiopia. BMC Public Health 15. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4549910.
. Megerso A, Garoma S, Eticha T, Workineh T, Daba Sh, Tarekegn M. et al (2016) Predictors of loss to follow-up in antiretroviral treatment for adult patients in the Oromia region, Ethiopia. HIV/AIDS - Research and Palliative Care 8: 83–92. http://dx.doi.org/10.2147/HIV.S98137.
. Melaku Z, Lamb MR, Wang Ch, Lulseged S, Gadisa Ts, Ahmed S, et al (2015) Characteristics and outcomes of adult Ethiopian patients enrolled in HIV care and treatment: a multi-clinic observational study BMC Public Health 15:462. DOI 10.1186/s12889-015-1776-4.
. Matthew P Fox M and DSc, and Sydney Rosen MPA (2015) Retention of Adult Patients on Antiretroviral Therapy in Low-and Middle-Income Countries: Systematic Review and Metaanalysis 2008–2013. J Acquir Immune Defic Syndr. 69(1): 98–108. doi:10.1097/QAI.0000000000000553.
. Wandeler G, Keiser O, Pfeiffer K, Pestilli S, Fritz C, Labhardt ND, et al (2012) Outcomes of antiretroviral treatment programs in rural Southern Africa. J Acquir Immune Defic Syndr. 59(2):e9-16. doi: 10.1097/QAI.0b013e31823edb6a
. Theuring S, Mugenyi K, Rubaihayo J, Busingye P, Harms G (2015) Antiretroviral Therapy Programme Retention and Outcomes after 12 Months in a Retrospective Patient Cohort in Fort Portal, Uganda: The Ongoing Challenge of Male ART Performance. J AIDS Clin Res 6:423. doi:10.4172/2155-6113.1000423
. Ekouevi DK, Balestre E, Ba-Gomis FO, Eholie SP, Maiga M, Amani-Bosse C, et al (2010) Low retention of HIV-infected patients on antiretroviral therapy in 11 clinical centres in West Africa. Trop Med Int Health. 15 Suppl 1:34-42. doi: 10.1111/j.1365-3156.2010.02505.x.
. Bucciardini R, Fragola V, Abegaz T, Lucattini S, Halifom A, Tadesse E, et al (2017) Predictors of attrition from care at 2 years in a prospective cohort of HIV-infected adults in Tigray, Ethiopia. BMJ Glob Health 2:e000325. Doi:10.1136/bmjgh-2017-000325.
. Assefa Y, Lynen L, Kloos H, Hill P, Rasschaert F, Hailemariam D, et al (2015) Brief report: long-term outcomes and their determinants in patients on antiretroviral treatment in Ethiopia, 2005/6-2011/12: a retrospective cohort study. J Acquir Immune Defic Syndr. 70(4):414-9. doi: 10.1097/QAI.0000000000000753
. Tadesse and Haile (2014) Predictors of Loss to Follow Up of Patients Enrolled on Antiretroviral Therapy: A Retrospective Cohort Study; J AIDS Clin Res 5:12 http://dx.doi.org/10.4172/2155-6113.1000393.
. Amin S Hassan, Shalton M Mwaringa, Kennedy K Ndirangu, Eduard J Sanders, Tobias F Rinke de Wit and James A Berkley (2015) Incidence and predictors of attrition from antiretroviral care among adults in a rural HIV clinic in Coastal Kenya: a retrospective cohort study; BMC Public Health 15:478. DOI 10.1186/s12889-015-1814-2.
. Assefa Y, Kiflie A, Tesfaye D, Haile Mariam D, Kloos H, Edwin W, et al (2011) Outcomes of antiretroviral treatment program in Ethiopia: Retention of patients in care is a major challenge and varies across health facilities: BMC Health Services Research 11:81; https://doi.org/10.1186/1472-6963-11-81.
. Dessalegn M, Tsadik M, Lemma H (2010) Predictors of lost to follow up to antiretroviral therapy in primary public hospital of Wukro, Tigray, Ethiopia: A case control study. Journal of AIDS and HIV Research. J Int AIDS Soc. 13:49. doi: 10.1186/1758-2652-13-49.
. Brennan AT, Maskew M, Sanne I, Fox MP (2010) The importance of clinic attendance in the fi rst six months on antiretroviral treatment: A retrospective analysis at a large public sector HIV clinic in South Africa. J Int AIDS Soc. 13:49. doi: 10.1186/1758-2652-13-49.
. Taiwo B (2009) Understanding transmitted HIV resistance through the experience in the USA. International Journal of Infectious Diseases Volume 13, Issue 5, Pages 552-559. https://doi.org/10.1016/j.ijid.2008.10.008
. Brennan AT, Maskew M, Sanne I, Fox MP. The importance of clinic attendance in the first six months on antiretroviral treatment: A retrospective analysis at a large public sector HIV clinic in South Africa. J Int AIDS Soc. 13:49. doi: 10.1186/1758-2652-13-49.
. Adama town health departiment/Adama Hospital Medical College report, 2017.
. Rachlis B, Bakoyannis G, Easterbrook P, Genberg B, Braithwaite RS, Cohen CR, et al. (2016) Facility-Level Factors Influencing Retention of Patients in HIV Care in East Africa. PLoS ONE 11(8): e0159994. doi:10.1371/journal.pone.0159994.
. World Health Organization (2013) Global update on HIV treatment: Results, impact and opportunities. http://www.who.int/about/licensing/copyright_form/ en/index.html).
. Rao D, Kekwaletswe TC, Hosek S, Martinez J, Rodriguez F (2007) Stigma and social barriers to medication adherence with urban youth living with HIV. AIDS Care 19(1):28–33. DOI: 10.1080/09540120600652303
. Arrive E, Dicko F, Amghar H, Aka AE, Dior H, Bouah B, et al (2012) HIV status disclosure and retention in care in HIV-infected adolescents on antiretroviral therapy (ART) in West Africa. PLoS One. 7(3), e33690. https://doi.org/10.1371/journal.pone.0033690
. Centers for Disease Control and Prevention (CDC) (2013) Differences between HIV-Infected men and women in antiretroviral therapy outcomes - six African countries, 2004-2012. MMWR Morb Mortal Wkly Rep 62:945–52 https://www.cdc.gov/mmwr/preview/mmwrhtml/mm6247a2.htm.
. Cornell M, Schomaker M, Garone DB, Giddy J, Hoffmann ChJ, Lessells R, et al (2012) Gender differences in survival among adult patients starting antiretroviral therapy in South Africa: a multicentre cohort study. PLoS Med 9:e1001304. https://doi.org/10.1371/journal.pmed.1001304
. Muula AS, Ngulube TJ, Siziya S, Makupe CM, Umar E, Prozesky HW, et al (2007) Gender distribution of adult patients on highly active antiretroviral therapy (HAART) in Southern Africa: a systematic review. PMID: 17459154 PMCID: PMC1868718 DOI: 10.1186/1471-2458-7-63
. Maskew M, Brennan AT, Westreich D, McNamara L, MacPhail AP, Fox MP (2013) Gender differences in mortality and CD4 count response among virally suppressed HIVpositive patients. J Womens Health (Larchmt). 22(2):113-20. doi: 10.1089/jwh.2012.3585.
. Takarinda KC, Harries AD, Shiraishi RW, Mutasa-Apollo T4, Abdul-Quader A, Mugurungi et al (2015) Gender-related differences in outcomes and attrition on antiretroviral treatment among an HIV-infected patient cohort in Zimbabwe: 2007-2010. Int J Infect Dis 30:98-105. doi: 10.1016/j.ijid.2014.11.009. Epub 2014 Nov 15.
. Taylor-Smith K, Tweya H, Harries A, Schoutene E, Jahn A (2010) Gender differences in retention and survival on antiretroviral therapy of HIV-1 infected adults in Malawi. Malawi Med J 22:49-56. https://www.ncbi.nlm.nih.gov/pubmed/21614882
. Braitstein P, Boulle A, Nash D, Brinkhof MW, Dabis F, Laurent C, et al (2008) Gender and the use of antiretroviral treatment in resource-constrained settings: findings from a multicenter collaboration. J Womens Health (Larchmt). 17(1):47-55. doi: 10.1089/jwh.2007.0353.
. Mukora R, Charalambous S, Dahab M, Hamilton R, Karstaedt A (2011) A study of patient attitudes towards decentralization of HIV Care in an urban clinic in South Africa. BMC Health Serv Res. 11: 205 doi: 10.1186/1472-6963-11-205PMID:21871068.
. Fox MP, Rosen S (2013) Retention of Adult Patients on Antiretroviral Therapy in Low- and Middle-Income Countries: Systematic Review and Meta-analysis 2008-2013. J Acquir Immune Defic Syndr. 2015 May 1;69(1):98-108. doi: 10.1097/QAI.0000000000000553.
. Van GJ, Thai (2011) Predictors of immune recovery and the association with late mortality while on antiretroviral treatment in Cambodia. Trans R Soc Trop Med Hyg 105: 694–703.S0035-9203(11)00168-4 (pii); doi:10.1016/j.trstmh.2011.08.007.