Dr Bogalech Gebre Memorial General Hospital, Durame, Ethiopia.
College of Health and Medical Science, Haramaya University, Harar, Ethiopia.
Front Public Health. 2024 Mar 13;12:1374515. doi: 10.3389/fpubh.2024.1374515. eCollection 2024.
Globally, loss to follow-up (LTFU) remains a significant public health concern despite the rapid expansion of antiretroviral medication programs. It is a significant cause of treatment failure and threatens the enhancement of HIV treatment outcomes among patients on antiretroviral therapy (ART). However, there is a paucity of evidence on its incidence and predictors in Ethiopia. Thus, this study aimed to examine the incidence and predictors of LTFU among adult HIV patients receiving ART at hospitals in Central Ethiopia.
A multi-centered facility-based retrospective cohort study was conducted among 432 randomly selected adult patients who received antiretroviral therapy. Data were entered into EpiData version 3.1 and exported to Stata version 14 for analysis. The Kaplan-Meier failure function was employed to determine the overall failure estimates, and the log-rank test was used to compare the probability of failure among the different categories of variables. The Cox proportional hazard model was used to identify independent predictors of LTFU.
Overall, 172 (39.8%) study participants were lost to follow-up over the 10-year follow-up period with an incidence rate of 8.12 (95% CI: 7.11, 9.09) per 1,000 person-months. Undisclosed HIV status (AHR: 1.96, 95% CI: 1.14, 3.36), not able to work (AHR: 1.84, 95% CI: 1.13, 2.22), opportunistic infections (AHR: 3.13, 95% CI: 2.17, 4.52), CD4 < 200 cell/mL (AHR: 1.95, 95% CI: 1.18, 3.21), not receiving isoniazid preventive therapy (IPT) (AHR: 2.57, 95% CI: 1.62, 4.06), not participating in clubs (AHR: 1.68, 95% CI: 1.10, 2.22), side effects of drugs (AHR: 1.44, 95% CI: 1.02, 2.04), and high viral load (AHR: 3.15, 95% CI: 1.81, 5.47) were identified as significant predictors of loss to follow-up.
In this study, the incidence of LTFU was high. The focus should be on creating awareness and prevention programs that aim to reduce loss to follow-up by continuing counseling, especially on the negative effects of loss to follow-up and the benefits of ART care.
尽管抗逆转录病毒药物方案迅速扩大，但全球范围内，失访（LTFU）仍然是一个严重的公共卫生问题。它是治疗失败的一个重要原因，并威胁到接受抗逆转录病毒疗法（ART）的患者的 HIV 治疗结果的提高。然而，在埃塞俄比亚，关于其发病率和预测因素的证据很少。因此，本研究旨在检查在埃塞俄比亚中部医院接受 ART 的成年 HIV 患者中 LTFU 的发病率和预测因素。
这是一项多中心基于机构的回顾性队列研究，共纳入了 432 名随机选择的接受抗逆转录病毒治疗的成年患者。数据输入 EpiData 版本 3.1 并导出到 Stata 版本 14 进行分析。Kaplan-Meier 失效函数用于确定总体失效估计值，对数秩检验用于比较不同类别变量之间的失效概率。Cox 比例风险模型用于确定 LTFU 的独立预测因素。
总体而言，在 10 年的随访期间，有 172 名（39.8%）研究参与者失访，1000 人月的失访率为 8.12（95%CI：7.11，9.09）。未公开的 HIV 状态（AHR：1.96，95%CI：1.14，3.36）、无法工作（AHR：1.84，95%CI：1.13，2.22）、机会性感染（AHR：3.13，95%CI：2.17，4.52）、CD4<200 个细胞/ml（AHR：1.95，95%CI：1.18，3.21）、未接受异烟肼预防性治疗（IPT）（AHR：2.57，95%CI：1.62，4.06）、不参加俱乐部（AHR：1.68，95%CI：1.10，2.22）、药物副作用（AHR：1.44，95%CI：1.02，2.04）和高病毒载量（AHR：3.15，95%CI：1.81，5.47）被确定为 LTFU 的显著预测因素。
在这项研究中，LTFU 的发生率很高。应重点制定旨在通过持续提供咨询来减少失访的意识和预防计划，特别是关于失访的负面影响和 ART 护理的益处。
