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Predictors of attrition from care at 2 years in a prospective cohort of HIV-infected adults in Tigray, Ethiopia
  1. Raffaella Bucciardini1,
  2. Vincenzo Fragola1,
  3. Teshome Abegaz2,
  4. Stefano Lucattini1,
  5. Atakilt Halifom3,
  6. Eskedar Tadesse2,
  7. Micheal Berhe2,
  8. Katherina Pugliese1,
  9. Luca Fucili1,
  10. Massimiliano Di Gregorio1,
  11. Marco Mirra1,
  12. Paola De Castro1,
  13. Roberta Terlizzi1,
  14. Paola Tatarelli4,
  15. Andrea Binelli1,
  16. Teame Zegeye3,
  17. Michela Campagnoli1,
  18. Stefano Vella1,
  19. Loko Abraham2,
  20. Hagos Godefay3
  1. 1Istituto Superiore di Sanità, Rome, Italy
  2. 2College of Health Sciences, Mekelle University, Mekelle, Ethiopia
  3. 3Tigray Regional Health Bureau, Mekelle, Ethiopia
  4. 4Department of Infectious Diseases, Università degli studi di Genova, Genoa, Italy
  1. Correspondence to Dr Raffaella Bucciardini; raffaella.bucciardini{at}iss.it

Abstract

Introduction Ethiopia has experienced rapid expansion of antiretroviral therapy (ART). However, as long-term retention in ART therapy is key for ART effectiveness, determinants of attrition need to be identified so appropriate interventions can be designed.

Methods We used data from the ‘Cohort of African people Starting Antiretroviral therapy’ (CASA) project, a prospective study of a cohort of HIV-infected patients who started ART in seven health facilities (HFs). We analysed the data of patients who had started first-line ART between January 2013 and December 2014. The Kaplan–Meier method was used to estimate the probability of retention at different time points. The Cox proportional hazards model was used to identify factors associated with attrition.

Results A total of 1198 patients were included in the study. Kaplan–Meier estimates of retention in care were 83.9%, 82.1% and 79.8% at 12, 18 and 24 months after starting ART, respectively. Attrition was mainly due to loss to follow-up, transferred-out patients and documented mortality. A multivariate Cox proportional hazard model showed that male sex, CD4 count <200 cells/µL and the type of HF were significantly associated with attrition.

Conclusions The observed attrition differences according to gender suggest that separate interventions designed for women and men should be explored. Moreover, innovative strategies to increase HIV testing should be supported to avoid CD4 levels falling too low, a factor significantly associated with higher attrition in our study. Finally, specific studies to analyse the reasons for different levels of attrition among HFs are required.

  • retention in care
  • attrition
  • antiretroviral treatment
  • loss-to follow-up
  • mortality

This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/

https://doi.org/10.1136/bmjgh-2017-000325

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    Footnotes

    • Contributors All authors contributed to this paper.

    • Funding This work was supported by the Italian Ministry of Health—Department of Prevention and Innovation, Rome, Italy; the Italian Development Cooperation; EDCTP2 Participating States' Initiated Activity (PSIA-2017-1208).

    • Competing interests None declared.

    • Patient consent Obtained.

    • Ethics approval Ethics approval was obtained from Mekelle University College of Health Sciences Research and Community Service Council. All patients provided written informed consent. For patients aged 14 to 18 the informed consent was signed by adult relatives acting as guardians (immediate families, e.g. father or mother or next of kin) and not by the patients themselves.

    • Provenance and peer review Not commissioned; externally peer reviewed.