The incidence of LTFU among adults on ART in Guji zone was high, particularly during the first year of treatment, and targeted interventions including enhanced counseling for high-risk groups, community-based ART refill models, and active phone-based tracking systems should be implemented to improve retention.
Abstract
Antiretroviral therapy (ART) has significantly improved outcomes for people living with HIV (PLHIV) globally. However, loss to follow-up (LTFU) remains a major barrier to the effectiveness of ART programs, particularly in resource-limited settings. In Ethiopia, LTFU contributes substantially to patient attrition, yet data from high-burden zones like Guji remain limited. Therefore, this study aimed to determine the incidence rate and identify predictors of loss to follow-up among HIV-infected adults receiving ART at public health facilities in Guji zone, Southern Ethiopia, 2023. An institution-based retrospective cohort study was conducted among 434 HIV-positive adults who initiated ART between July 2018 and June 2022 at public health facilities in Guji zone. Participants were selected using simple random sampling. Data were extracted from medical records using a structured checklist and entered into Epi Data 4.6.2. Analysis was performed using SPSS 25 and STATA 14. The incidence rate of LTFU (defined as >30 days since last scheduled appointment date and has not been classified as “dead” or “transferring out) was calculated per 100 person-years. Bivariable and multivariable Cox proportional hazards regression were used to identify predictors of LTFU. Adjusted hazard ratios (AHR) with 95% confidence intervals and p-values < 0.05 were considered statistically significant. Among 434 participants (60% female) followed for 904.35 person-years, 135 (31.1%) were lost to follow-up, yielding an incidence rate of 14.93 per 100 person-years. Factors significantly associated with higher LTFU risk were: male sex (AHR = 1.85, 95%CI: 1.27–2.69), age 15–30 years (AHR = 2.40, 95%CI: 1.58–3.64), female sex work (AHR = 3.26, 95%CI: 1.39–7.65), daily labor/mobile work (AHR = 1.91, 95%CI: 1.16–3.16), and no formal education (AHR = 2.20, 95%CI: 1.52–3.20). Protective factors associated with lower LTFU risk were: residing in the same woreda as the health facility (AHR = 0.55, 95%CI: 0.38–0.82) and having a documented phone number (AHR = 0.46, 95%CI: 0.31–0.67). The incidence of LTFU among adults on ART in Guji zone was high, particularly during the first year of treatment. Male sex, younger age, lack of formal education, female sex work, and daily labor were associated with increased LTFU risk, while residing in the same woreda as the health facility and having documented phone numbers were protective. Targeted interventions including enhanced counseling for high-risk groups, community-based ART refill models, and active phone-based tracking systems should be implemented to improve retention.
BACKGROUND
Loss to follow-up (LTFU) remains a significant global public health challenge, particularly among patients receiving antiretroviral therapy (ART). There is paucity of information on incidence and predictors of LTFU in the Metekel zone, which limits the ability to monitor the effectiveness intervention.
OBJECTIVE
To assess the incidence and identify the predictors of loss to follow-up among adult people living with HIV at public health facilities in the Metekel Zone, Northwest Ethiopia.
METHODS
A retrospective cohort study was conducted among 540 people living with HIV who enrolled in ART from June 28, 2017, to June 27, 2022, in the Metekel Zone. The study was conducted in one public hospital and eight public health centers. Patient records were randomly selected and extracted using a structured checklist. The Kaplan-Meier curves were compared using the log-rank test, and the Cox proportional hazard model was used to identify the independent predictors of LTFU. The strength of the association was measured using adjusted hazard ratio (AHR) along with 95% confidence intervals (CIs).
RESULTS
Among 540 participants, 304 (56.3%) were females and the mean (SD) age participants was 35.7(12.41) years. The overall LTFU incidence rate was 15.12 (95% CI: 12.9-17.6) per 100 person-years. Tuberculosis infection at baseline (AHR: 2.12 95% CI: 1.33 - 3.38), underweight at ART initiation (AHR: 5.36, 95% CI: 3.46-8.31), poor ART adherence (AHR: 2.14, 95% CI: (1.32 - 3.46), and most recent viral load > 1000 copies/mL (AHR: 2.71, 95% CI: 1.55 - 4.72) were identified significant predictors of LTFU.
CONCLUSION
The observed LTFU incidence rate among adults receiving ART in Metekel Zone was notably higher than documented in prior studies. Hence, enhanced monitoring and support strategies should target patients with baseline tuberculosis infection, poor treatment adherence, underweight at baseline, and high viral load, particularly within the first year of treatment initiation. In addition, effective strategies to improve patient retention in HIV care should be designed considering the identified risk factors.
Temesgen Desalegn Balda, Abraham Lomboro Dimore, Chaltu Fikru Biyana· Journal of Health, Populatio...· 0 citations
Tuberculosis incidence was relatively low, while isoniazid use was protective, and poor adherence, opportunistic infections, and large family size increased risk, while isoniazid use was protective.
Wabiw Addis, Adugnaw Zeleke, S. Nigatu et al.· Journal of the International...· 0 citations
INTRODUCTION
Adolescents and young adults living with HIV (AYLHIV) experience poor outcomes across the care continuum, and most reside in sub-Saharan Africa. The African Cohort Study (AFRICOS) provides an opportunity to examine HIV outcomes in this population across Kenya, Nigeria, Tanzania, and Uganda.
METHODS
We conducted a cross-sectional analysis of AYLHIV aged 15-29 years, enrolled in AFRICOS 2013-2023, and on antiretroviral therapy (ART) ≥ six months. Primary outcomes were HIV viremia and 30-day ART non-adherence. Factors included HIV acquisition route, ART duration, ART class, and site. We used multivariate robust Poisson regression to estimate relative risks (RRs) and 95% confidence intervals (CIs). Site directors were surveyed to assess youth-friendly services.
RESULTS
Among 656 participants, the median age was 20.0 years (IQR 17.5-23.3); 41.6% were male, 61.6% had perinatally-acquired HIV, and median duration since HIV diagnosis was nine years. At enrollment, 83.8% had viral suppression (<200 copies/mL) and 80.2% were ART adherent. ART regimen and clinic site were associated with viral suppression: youth on integrase vs. protease inhibitor-based regimens (adjusted relative risk (aRR) 0.38, CI 0.23-0.63, p<0.001), and in Uganda (aRR 0.42, CI 0.20-0.90, p=0.026) or Kisumu, Kenya (aRR 0.40, CI 0.22-0.76, p=0.005) had lower likelihood of non-suppression. Compared to Nigeria, participants from other sites were less likely to report non-adherence (unadjusted RR 0.31-0.44). Youth-friendly service provision varied.
CONCLUSIONS
Viral suppression and ART adherence were high among AYLHIV in AFRICOS. Clinic site and ART regimen were associated with outcomes, highlighting the importance of health system factors.
M. Brault, Aima A. Ahonkhai, Seth Frndak et al.· Journal of Acquired Immune D...· 0 citations
Objective This study aimed to identify determinants of late ART initiation among adults living with HIV in public health facilities of West Guji Zone, Oromia, Ethiopia. Methods Unmatched case–control study was conducted among 226 adults living with HIV (113 cases and 113 controls) selected by simple random sampling. Data was collected using an interviewer-administered questionnaire and analyzed using SPSS version 25. Multivariable logistic binary regression was used to identify determinants of late ART initiation. Results Late ART initiation was associated with inability to read and write (AOR = 6.21, 95% CI: 2.32–7.98), rural residence (AOR = 4.26, 95% CI: 1.23–14.74), fear of job loss (AOR = 8.43, 95% CI: 6.72–20.05), lack of family support (AOR = 7.28, 95% CI: 1.90–12.19), absence of intention to protect family members (AOR = 6.16, 95% CI: 4.15–12.97), visiting traditional healers (AOR = 5.24, 95% CI: 1.51–13.40), and contact with commercial sex workers (AOR =5.59, 95% CI: 4.07–13.80). Conclusions Delayed ART initiation was driven by interacting sociodemographic, psychosocial, and behavioral factors. Addressing social disadvantages, fear-related concerns, weak family support, and reliance on non-formal care pathways is essential to promote timely initiation of ART.
Atsedemariam Mamo, Melese Tikusie Tewoldie, Z. B. Mamo· Journal of the International...· 0 citations
Background: Human Immunodeficiency Virus (HIV) continues to pose a major global public health challenge, especially in low and middle income countries. Sustained adherence to Antiretroviral Therapy (ART) is fundamental to achieving viral suppression, preventing disease progression, and reducing transmission. Despite advances in treatment availability, suboptimal adherence continues to hinder optimal clinical outcomes.
Aims: This study aimed to examine the key determinants influencing ART adherence among people living with HIV (PLHIV) in North Sumatra, Indonesia.
Methods: A quantitative cross-sectional study was conducted from April to December 2024 at Dr. Ferdinand Lumbantobing General Hospital, Sibolga City. All 88 PLHIV receiving ART during the period were recruited using total sampling. Data were collected via structured questionnaires and analyzed using univariate analysis, chi-square tests, and multivariate logistic regression to identify significant adherence predictors.
Results: ART adherence was significantly associated with treatment-related knowledge, family support, healthcare provider support, and access to healthcare facilities (p < 0.05). Multivariate logistic regression revealed that treatment knowledge was the most influential determinant of adherence, followed by family support, healthcare provider support, and healthcare accessibility.
Conclusion: ART adherence in this tropical setting is shaped by a dynamic interplay of individual understanding and social and healthcare system support. Strengthening patient education, fostering family engagement, and improving access to healthcare services are essential strategies for sustaining treatment adherence over time. Future longitudinal research is warranted to explore adherence trajectories and evaluate targeted intervention models
Lidya C. M. Hutapea, T. Widyawati, Rodiah Rahmawaty Lubis et al.· Jurnal Kesehatan· 0 citations
Background Community-based ART service delivery brings HIV care closer to clinically stable clients and may improve outcomes while reducing burdens on patients and health facilities. However, evidence from low income setting remains limited. Methods Institution based retrospective follow-up study was conducted from 422 adult ART users selected by simple random sampling. Data were analyzed using STATA 15. Multivariable Cox proportional hazards regression identified predictors of treatment outcomes. Results The cumulative incidence of good ART treatment outcome was 81.99% (95% CI: 77.98–85.54%). Median survival time was 11 months (IQR: 5–12). Missing ART doses reduced survival by 54% (AHR=0.46; 95% CI: 0.22–0.95). Good retention in care (AHR=1.58), tuberculosis prophylaxis (AHR=1.38), and adequate drug supply (AHR=1.39) significantly improved survival. Conclusion Treatment outcomes were suboptimal. Strengthening retention, tuberculosis prophylaxis, drug supply, and adherence support could improve survival.
Tadewos Kassaw Tarekegn, Hailemarriam Mekonnen, Birhanu Melaku et al.· Journal of the International...· 0 citations
