Tsadik Mache, Berhane Yemane, Worku Alemayehu, Terefe Wondwossen
College of Health Science, Mekelle University, Tigray, Ethiopia.
Addis Continental Institute of Public Health, Addis Ababa, Ethiopia.
BMJ Open. 2017 Jul 17;7(7):e016864. doi: 10.1136/bmjopen-2017-016864.
The loss to follow-up (LTFU) among patients attending care for sexually transmitted infections (STIs) in Sub-Saharan Africa is a major barrier to achieving the goals of the STI prevention and control programme. The objective of this study was to investigate individual- and facility-level factors associated with LTFU among patients treated for STIs in Ethiopia.
A prospective cohort study was conducted among patients attending care for STIs in selected facilities from January to June 2015 in the Tigray region of Ethiopia. LTFU was ascertained if a patient did not present in person to the same facility within 7 days of the initial contact. Multilevel logistic regression was used to identify factors associated with LTFU.
Out of 1082 patients, 59.80% (647) were LTFU. The individual-level factors associated with LTFU included having multiple partners (adjusted OR (AOR) 2.89, 95% CI 1.74 to 4.80), being male (AOR 2.23, 95% CI 1.63 to 3.04), having poor knowledge about the means of STI transmission (AOR 2.08, 95% CI 1.53 to 2.82), having college level education (AOR 0.38, 95% CI 0.22 to 0.65), and low perceived stigma (AOR 0.60, 95% CI 0.43 to 0.82). High patient flow (AOR 3.06, 95% CI 1.30 to 7.18) and medium health index score (AOR 2.80, 95% CI 1.28 to 6.13) were facility-level factors associated with LTFU.
Improving patient retention in STI follow-up care requires focused interventions targeting those who are more likely to be LTFU, particularly patients with multiple partners, male index cases and patients attending facilities with high patient flow.
在撒哈拉以南非洲地区，接受性传播感染（STIs）治疗的患者失访是实现性传播感染预防和控制计划目标的主要障碍。本研究的目的是调查埃塞俄比亚接受性传播感染治疗的患者中与失访相关的个体和机构层面因素。
2015年1月至6月，在埃塞俄比亚提格雷地区选定的机构中，对接受性传播感染治疗的患者进行了一项前瞻性队列研究。如果患者在初次接触后7天内未亲自到同一机构就诊，则确定为失访。采用多水平逻辑回归分析来确定与失访相关的因素。
在1082名患者中，59.80%（647名）失访。与失访相关的个体层面因素包括有多个性伴侣（调整后的比值比（AOR）为2.89，95%置信区间为1.74至4.80）、男性（AOR为2.23，95%置信区间为1.63至3.04）、对性传播感染传播途径了解不足（AOR为2.08，95%置信区间为1.53至2.82）、受过大学教育（AOR为0.38，95%置信区间为0.22至0.65）以及低感知耻辱感（AOR为0.60，95%置信区间为0.43至0.82）。患者流量大（AOR为3.06，95%置信区间为1.30至7.18）和中等健康指数评分（AOR为2.80，95%置信区间为1.28至6.13）是与失访相关的机构层面因素。
提高性传播感染随访护理中的患者留存率需要针对那些更有可能失访的人群进行有针对性的干预，特别是有多个性伴侣的患者、男性索引病例以及在患者流量大的机构就诊的患者。
