Guyo Tamirat Gezahegn, Sapo Abraham Anbesie, Merid Fasika, Sahile Serekebirahan, Kefene Simegn Wagaye, Toma Temesgen Mohammed
Department of Public Health, Arba Minch College of Health Sciences, Arba Minch, Ethiopia
Department of Environmental Health, Arba Minch College of Health Sciences, Arba Minch, Ethiopia.
BMJ Open. 2025 Apr 23;15(4):e093129. doi: 10.1136/bmjopen-2024-093129.
This study aimed to determine the incidence of attrition and its predictors among HIV-infected adolescents receiving antiretroviral therapy in public hospitals, South Ethiopia.
A multicentre retrospective follow-up study was conducted, and Cox proportional hazards model was used to identify predictors of the study outcome variable (attrition).
The study was conducted in eight public hospitals (two general and six primary hospitals) in South Ethiopia.
Adolescents (10-19 years) on antiretroviral therapy from 1 January 2014 to 30 December 2023 (n=409). The data were collected from patients' charts and electronic data records.
The primary outcome was time to attrition, and the secondary outcome was predictors of attrition.
The overall incidence density of attrition was 3.33 (95% CI: 2.65 to 4.18) per 100 person-year of observation. Age 15-19 years (adjusted HR (AHR): 1.88; 95% CI: 1.12 to 3.18), death of both the parents (AHR: 2.19; 95% CI: 1.04 to 4.61), no formal education (AHR: 3.16; 95% CI: 1.48 to 6.77), Co-trimoxazole Prophylactic Therapy (CPT) non-utilisation (AHR: 1.73; 95% CI: 1.03 to 2.91), not changed regimen (AHR: 6.16; 95% CI: 3.56 to 10.66) and poor treatment adherence (AHR: 5.16; 95% CI: 2.35 to 11.32) were predictors of attrition.
Attrition was identified to be a significant public health problem in study settings. Moreover, old age, parental death, not attending formal education, not using CPT, unchanged baseline regimen and suboptimal treatment adherence predict attrition. Hence, special attention should be given to older adolescents, those with no formal education, orphaned and with poor baseline clinical characteristics. Likewise, early tracing of missed follow-up schedules, improving adherence support and increasing contacting frequency to reduce attrition are highly encouraged.
本研究旨在确定埃塞俄比亚南部公立医院接受抗逆转录病毒治疗的艾滋病毒感染青少年中治疗中断的发生率及其预测因素。
进行了一项多中心回顾性随访研究，并使用Cox比例风险模型来确定研究结果变量（治疗中断）的预测因素。
研究在埃塞俄比亚南部的八家公立医院（两家综合医院和六家基层医院）进行。
2014年1月1日至2023年12月31日接受抗逆转录病毒治疗的青少年（10 - 19岁）（n = 409）。数据从患者病历和电子数据记录中收集。
主要结果是治疗中断时间，次要结果是治疗中断的预测因素。
每100人年观察期的治疗中断总体发病密度为3.33（95%置信区间：2.65至4.18）。15 - 19岁（调整后风险比（AHR）：1.88；95%置信区间：1.12至3.18）、双亲死亡（AHR：2.19；95%置信区间：1.04至4.61）、未接受正规教育（AHR：3.16；95%置信区间：1.48至6.77）、未使用复方新诺明预防性治疗（CPT）（AHR：1.73；95%置信区间：1.03至2.91）、未更换治疗方案（AHR：6.16；95%置信区间：3.56至10.66）以及治疗依从性差（AHR：5.16；95%置信区间：2.35至11.32）是治疗中断的预测因素。
在研究环境中，治疗中断被确定为一个重大的公共卫生问题。此外，年龄较大、父母死亡、未接受正规教育、未使用CPT、基线治疗方案未改变以及治疗依从性欠佳可预测治疗中断。因此，应特别关注年龄较大的青少年、未接受正规教育者、孤儿以及基线临床特征较差者。同样，强烈鼓励尽早追踪错过的随访计划、加强依从性支持并增加联系频率以减少治疗中断。
