Do loss to follow-up and death rates from ART care vary across primary health care facilities and hospitals in south Ethiopia? A retrospective follow-up study

Wondu Teshome,1 Mehretu Belayneh,1 Mathewos Moges,1 Emebet Mekonnen,2 Misganu Endrias,2 Sinafiksh Ayele,2 Tebeje Misganaw,2 Mekonnen Shiferaw,2 Tigist Tesema2 1School of Public and Environmental Health, Hawassa University, 2Health Research and Technology Transfer Support Process, Southern Nations Na...

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Autores principales:	Teshome W, Belayneh M, Moges M, Mekonnen E, Endrias M, Ayele S, Misganaw T, Shiferaw M, Tesema T
Formato:	article
Lenguaje:	EN
Publicado:	Dove Medical Press 2015
Materias:	Immunologic diseases. Allergy RC581-607
Acceso en línea:	https://doaj.org/article/833ed8ac053c4a00bbd29d58df03c619
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spelling	oai:doaj.org-article:833ed8ac053c4a00bbd29d58df03c6192021-12-02T06:31:36ZDo loss to follow-up and death rates from ART care vary across primary health care facilities and hospitals in south Ethiopia? A retrospective follow-up study1179-1373https://doaj.org/article/833ed8ac053c4a00bbd29d58df03c6192015-05-01T00:00:00Zhttp://www.dovepress.com/do-loss-to-follow-up-and-death-rates-from-art-care-vary-across-primary-peer-reviewed-article-HIVhttps://doaj.org/toc/1179-1373Wondu Teshome,1 Mehretu Belayneh,1 Mathewos Moges,1 Emebet Mekonnen,2 Misganu Endrias,2 Sinafiksh Ayele,2 Tebeje Misganaw,2 Mekonnen Shiferaw,2 Tigist Tesema2 1School of Public and Environmental Health, Hawassa University, 2Health Research and Technology Transfer Support Process, Southern Nations Nationalities and Peoples' Regional Health Bureau, Hawassa, Ethiopia Background: Decentralization and task shifting has significantly improved access to antiretroviral therapy (ART). Many studies conducted to determine the attrition rate in Ethiopia have not compared attrition rates between hospitals and health centers in a relatively recent cohort of patients. This study compared death and loss to follow-up (LTFU) rates among ART patients in hospitals and health centers in south Ethiopia. Methods: Data routinely collected from patients aged older than 15 years who started ART between July 2011 and August 2012 in 20 selected health facilities (12 being hospitals) were analyzed. The outcomes of interest were LTFU and death. The data were entered, cleaned, and analyzed using Statistical Package for the Social Sciences version 20.0 and Stata version 12.0. Competing-risk regression models were used. Results: The service years of the facilities were similar (median 8 and 7.5 for hospitals and health centers, respectively). The mean patient age was 33.7±9.6 years. The median baseline CD4 count was 179 (interquartile range 93–263) cells/mm3. A total of 2,356 person-years of observation were made with a median follow-up duration of 28 (interquartile range 22–31) months; 24.6% were either dead or LTFU, resulting in a retention rate of 75.4%. The death rates were 3.0 and 1.5 and the LTFU rate were 9.0 and 10.9 per 100 person-years of observation in health centers and hospitals, respectively. The competing-risk regression model showed that the gap between testing and initiation of ART, body mass index, World Health Organization clinical stage, isoniazid prophylaxis, age, facility type, and educational status were independently associated with LTFU. Moreover, baseline tuberculous disease, poor functional status, and follow-up at a health center were associated with an elevated probability of death. Conclusion: We observed a higher death rate and a lower LTFU rate in health centers than in hospitals. Most of the associated variables were also previously documented. Higher LTFU was noticed for patients with a smaller gap between testing and initiation of treatment. Keywords: antiretroviral therapy, primary care, loss to follow-up, death rates, EthiopiaTeshome WBelayneh MMoges MMekonnen EEndrias MAyele SMisganaw TShiferaw MTesema TDove Medical PressarticleImmunologic diseases. AllergyRC581-607ENHIV/AIDS: Research and Palliative Care, Vol 2015, Iss default, Pp 167-174 (2015)
institution	DOAJ
collection	DOAJ
language	EN
topic	Immunologic diseases. Allergy RC581-607
spellingShingle	Immunologic diseases. Allergy RC581-607 Teshome W Belayneh M Moges M Mekonnen E Endrias M Ayele S Misganaw T Shiferaw M Tesema T Do loss to follow-up and death rates from ART care vary across primary health care facilities and hospitals in south Ethiopia? A retrospective follow-up study
description	Wondu Teshome,1 Mehretu Belayneh,1 Mathewos Moges,1 Emebet Mekonnen,2 Misganu Endrias,2 Sinafiksh Ayele,2 Tebeje Misganaw,2 Mekonnen Shiferaw,2 Tigist Tesema2 1School of Public and Environmental Health, Hawassa University, 2Health Research and Technology Transfer Support Process, Southern Nations Nationalities and Peoples' Regional Health Bureau, Hawassa, Ethiopia Background: Decentralization and task shifting has significantly improved access to antiretroviral therapy (ART). Many studies conducted to determine the attrition rate in Ethiopia have not compared attrition rates between hospitals and health centers in a relatively recent cohort of patients. This study compared death and loss to follow-up (LTFU) rates among ART patients in hospitals and health centers in south Ethiopia. Methods: Data routinely collected from patients aged older than 15 years who started ART between July 2011 and August 2012 in 20 selected health facilities (12 being hospitals) were analyzed. The outcomes of interest were LTFU and death. The data were entered, cleaned, and analyzed using Statistical Package for the Social Sciences version 20.0 and Stata version 12.0. Competing-risk regression models were used. Results: The service years of the facilities were similar (median 8 and 7.5 for hospitals and health centers, respectively). The mean patient age was 33.7±9.6 years. The median baseline CD4 count was 179 (interquartile range 93–263) cells/mm3. A total of 2,356 person-years of observation were made with a median follow-up duration of 28 (interquartile range 22–31) months; 24.6% were either dead or LTFU, resulting in a retention rate of 75.4%. The death rates were 3.0 and 1.5 and the LTFU rate were 9.0 and 10.9 per 100 person-years of observation in health centers and hospitals, respectively. The competing-risk regression model showed that the gap between testing and initiation of ART, body mass index, World Health Organization clinical stage, isoniazid prophylaxis, age, facility type, and educational status were independently associated with LTFU. Moreover, baseline tuberculous disease, poor functional status, and follow-up at a health center were associated with an elevated probability of death. Conclusion: We observed a higher death rate and a lower LTFU rate in health centers than in hospitals. Most of the associated variables were also previously documented. Higher LTFU was noticed for patients with a smaller gap between testing and initiation of treatment. Keywords: antiretroviral therapy, primary care, loss to follow-up, death rates, Ethiopia
format	article
author	Teshome W Belayneh M Moges M Mekonnen E Endrias M Ayele S Misganaw T Shiferaw M Tesema T
author_facet	Teshome W Belayneh M Moges M Mekonnen E Endrias M Ayele S Misganaw T Shiferaw M Tesema T
author_sort	Teshome W
title	Do loss to follow-up and death rates from ART care vary across primary health care facilities and hospitals in south Ethiopia? A retrospective follow-up study
title_short	Do loss to follow-up and death rates from ART care vary across primary health care facilities and hospitals in south Ethiopia? A retrospective follow-up study
title_full	Do loss to follow-up and death rates from ART care vary across primary health care facilities and hospitals in south Ethiopia? A retrospective follow-up study
title_fullStr	Do loss to follow-up and death rates from ART care vary across primary health care facilities and hospitals in south Ethiopia? A retrospective follow-up study
title_full_unstemmed	Do loss to follow-up and death rates from ART care vary across primary health care facilities and hospitals in south Ethiopia? A retrospective follow-up study
title_sort	do loss to follow-up and death rates from art care vary across primary health care facilities and hospitals in south ethiopia? a retrospective follow-up study
publisher	Dove Medical Press
publishDate	2015
url	https://doaj.org/article/833ed8ac053c4a00bbd29d58df03c619
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Do loss to follow-up and death rates from ART care vary across primary health care facilities and hospitals in south Ethiopia? A retrospective follow-up study

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