Attrition and Its Predictors Among Adults Receiving First-Line Antiretroviral Therapy in Woldia Town Public Health Facilities, Northeast Ethiopia: A Retrospective Cohort Study

Demeke Dejen,1 Dube Jara,2 Fanos Yeshanew,3 Zinabu Fentaw,4 Tesfa Mengie Feleke,5 Fentaw Girmaw,6 Birhanu Wagaye3 1Care and Treatment, Amhara Regional Health Bureau CDC Project Cluster Health Facilities HIV Case Detection Linkage, Woldia, Ethiopia; 2Department of Epidemiology and Biostatics, School...

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Autores principales:	Dejen D, Jara D, Yeshanew F, Fentaw Z, Mengie Feleke T, Girmaw F, Wagaye B
Formato:	article
Lenguaje:	EN
Publicado:	Dove Medical Press 2021
Materias:	attrition hiv/aids antiretroviral therapy retrospective cohort ethiopia. Immunologic diseases. Allergy RC581-607
Acceso en línea:	https://doaj.org/article/8cae7ba0b96340dc8068631b21326b66
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id	oai:doaj.org-article:8cae7ba0b96340dc8068631b21326b66
record_format	dspace
institution	DOAJ
collection	DOAJ
language	EN
topic	attrition hiv/aids antiretroviral therapy retrospective cohort ethiopia. Immunologic diseases. Allergy RC581-607
spellingShingle	attrition hiv/aids antiretroviral therapy retrospective cohort ethiopia. Immunologic diseases. Allergy RC581-607 Dejen D Jara D Yeshanew F Fentaw Z Mengie Feleke T Girmaw F Wagaye B Attrition and Its Predictors Among Adults Receiving First-Line Antiretroviral Therapy in Woldia Town Public Health Facilities, Northeast Ethiopia: A Retrospective Cohort Study
description	Demeke Dejen,1 Dube Jara,2 Fanos Yeshanew,3 Zinabu Fentaw,4 Tesfa Mengie Feleke,5 Fentaw Girmaw,6 Birhanu Wagaye3 1Care and Treatment, Amhara Regional Health Bureau CDC Project Cluster Health Facilities HIV Case Detection Linkage, Woldia, Ethiopia; 2Department of Epidemiology and Biostatics, School of Public Health, College of Medicine and Health Science, Addis Ababa University, Addis Ababa, Ethiopia; 3Department of Public Health Nutrition, School of Public Health, College of Medicine and Health Science, Wollo University, Dessie, Ethiopia; 4Department of Epidemiology and Biostatistics, School of Public Health, College of Medicine and Health Science, Wollo University, Dessie, Ethiopia; 5Amhara Regional Health Bureau CDC Project Zonal Monitoring and Evaluation, Dessie, Ethiopia; 6Department of Pharmacy, College of Health Science, Woldia University, Woldia, EthiopiaCorrespondence: Zinabu FentawDepartment of Epidemiology and Biostatistics, School of Public Health, College of Medicine and Health Science, Wollo University, Dessie, EthiopiaTel +251912757286Email zfentaw5@gmail.comIntroduction: There is an expansion and advancement of antiretroviral therapy. However, attrition of patients from HIV care is one of the major drivers of poor performance of HIV/AIDS programs, which leads to drug resistance, morbidity and mortality. The study aimed to assess the incidence of attrition and its predictors among adults receiving first-line antiretroviral therapy.Methods: An institution-based retrospective cohort study was conducted among 634 adults receiving antiretroviral therapy, and study participants were selected using a simple random sampling technique. Data were cleaned and entered into Epi Data version 3.1 and exported to STATA 14.1 for further analysis. The predictors of attrition were identified using bivariable and multivariable Cox Proportional hazard models; then, variables at a p-value of less than 0.25 and 0.05 were included in the multivariable analysis and statistically significant, respectively.Results: The total time observed was found to be 1807.08 person-years of observation with a median follow-up time of 2.67 years (IQR 1.25− 4.67). The incidence rate of attrition was 8.36 (95% CI: 7.12− 9.80) per 100 person-years. Significant predictors of attrition were being young age [adjusted hazard ratio (AHR) =2.0, 95% CI, (1.11− 3.58)], nearest calendar year of ART initiation [AHR =2.32, 95% CI, (1.08– 5.01)], bedridden functional status [AHR=3.25, 95% CI, (1.33− 7.96)], WHO stage III [AHR=3.57, 95% CI, (1.58− 8.06)] and stage IV [AHR=5.46, 95% CI, (1.97− 15.13)], viral load result of ≤ 1000 [AHR=0.11, 95% CI, (0.06− 0.23)], disclosure status [AHR=2.03, 95% CI, (1.22− 3.37)] and adherence level of poor [AHR=3.19, 95 CI, (1.67− 6.09)].Conclusion: The result of this study showed that the incidence of attrition among adults receiving antiretroviral therapy was high. However, as a standard, every client who started antiretroviral therapy should be retained. Positive predictors of attrition were young age (15– 24), recent year of ART initiation, baseline functional status, advanced WHO stage III and IV, no disclosure status, fair/poor adherence whereas, viral load result of ≤ 1000 copies/mL had a preventive effect on attrition.Keywords: attrition, HIV/AIDS, antiretroviral therapy, retrospective cohort, Ethiopia
format	article
author	Dejen D Jara D Yeshanew F Fentaw Z Mengie Feleke T Girmaw F Wagaye B
author_facet	Dejen D Jara D Yeshanew F Fentaw Z Mengie Feleke T Girmaw F Wagaye B
author_sort	Dejen D
title	Attrition and Its Predictors Among Adults Receiving First-Line Antiretroviral Therapy in Woldia Town Public Health Facilities, Northeast Ethiopia: A Retrospective Cohort Study
title_short	Attrition and Its Predictors Among Adults Receiving First-Line Antiretroviral Therapy in Woldia Town Public Health Facilities, Northeast Ethiopia: A Retrospective Cohort Study
title_full	Attrition and Its Predictors Among Adults Receiving First-Line Antiretroviral Therapy in Woldia Town Public Health Facilities, Northeast Ethiopia: A Retrospective Cohort Study
title_fullStr	Attrition and Its Predictors Among Adults Receiving First-Line Antiretroviral Therapy in Woldia Town Public Health Facilities, Northeast Ethiopia: A Retrospective Cohort Study
title_full_unstemmed	Attrition and Its Predictors Among Adults Receiving First-Line Antiretroviral Therapy in Woldia Town Public Health Facilities, Northeast Ethiopia: A Retrospective Cohort Study
title_sort	attrition and its predictors among adults receiving first-line antiretroviral therapy in woldia town public health facilities, northeast ethiopia: a retrospective cohort study
publisher	Dove Medical Press
publishDate	2021
url	https://doaj.org/article/8cae7ba0b96340dc8068631b21326b66
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spelling	oai:doaj.org-article:8cae7ba0b96340dc8068631b21326b662021-12-02T14:28:08ZAttrition and Its Predictors Among Adults Receiving First-Line Antiretroviral Therapy in Woldia Town Public Health Facilities, Northeast Ethiopia: A Retrospective Cohort Study1179-1373https://doaj.org/article/8cae7ba0b96340dc8068631b21326b662021-04-01T00:00:00Zhttps://www.dovepress.com/attrition-and-its-predictors-among-adults-receiving-first-line-antiret-peer-reviewed-fulltext-article-HIVhttps://doaj.org/toc/1179-1373Demeke Dejen,1 Dube Jara,2 Fanos Yeshanew,3 Zinabu Fentaw,4 Tesfa Mengie Feleke,5 Fentaw Girmaw,6 Birhanu Wagaye3 1Care and Treatment, Amhara Regional Health Bureau CDC Project Cluster Health Facilities HIV Case Detection Linkage, Woldia, Ethiopia; 2Department of Epidemiology and Biostatics, School of Public Health, College of Medicine and Health Science, Addis Ababa University, Addis Ababa, Ethiopia; 3Department of Public Health Nutrition, School of Public Health, College of Medicine and Health Science, Wollo University, Dessie, Ethiopia; 4Department of Epidemiology and Biostatistics, School of Public Health, College of Medicine and Health Science, Wollo University, Dessie, Ethiopia; 5Amhara Regional Health Bureau CDC Project Zonal Monitoring and Evaluation, Dessie, Ethiopia; 6Department of Pharmacy, College of Health Science, Woldia University, Woldia, EthiopiaCorrespondence: Zinabu FentawDepartment of Epidemiology and Biostatistics, School of Public Health, College of Medicine and Health Science, Wollo University, Dessie, EthiopiaTel +251912757286Email zfentaw5@gmail.comIntroduction: There is an expansion and advancement of antiretroviral therapy. However, attrition of patients from HIV care is one of the major drivers of poor performance of HIV/AIDS programs, which leads to drug resistance, morbidity and mortality. The study aimed to assess the incidence of attrition and its predictors among adults receiving first-line antiretroviral therapy.Methods: An institution-based retrospective cohort study was conducted among 634 adults receiving antiretroviral therapy, and study participants were selected using a simple random sampling technique. Data were cleaned and entered into Epi Data version 3.1 and exported to STATA 14.1 for further analysis. The predictors of attrition were identified using bivariable and multivariable Cox Proportional hazard models; then, variables at a p-value of less than 0.25 and 0.05 were included in the multivariable analysis and statistically significant, respectively.Results: The total time observed was found to be 1807.08 person-years of observation with a median follow-up time of 2.67 years (IQR 1.25− 4.67). The incidence rate of attrition was 8.36 (95% CI: 7.12− 9.80) per 100 person-years. Significant predictors of attrition were being young age [adjusted hazard ratio (AHR) =2.0, 95% CI, (1.11− 3.58)], nearest calendar year of ART initiation [AHR =2.32, 95% CI, (1.08– 5.01)], bedridden functional status [AHR=3.25, 95% CI, (1.33− 7.96)], WHO stage III [AHR=3.57, 95% CI, (1.58− 8.06)] and stage IV [AHR=5.46, 95% CI, (1.97− 15.13)], viral load result of ≤ 1000 [AHR=0.11, 95% CI, (0.06− 0.23)], disclosure status [AHR=2.03, 95% CI, (1.22− 3.37)] and adherence level of poor [AHR=3.19, 95 CI, (1.67− 6.09)].Conclusion: The result of this study showed that the incidence of attrition among adults receiving antiretroviral therapy was high. However, as a standard, every client who started antiretroviral therapy should be retained. Positive predictors of attrition were young age (15– 24), recent year of ART initiation, baseline functional status, advanced WHO stage III and IV, no disclosure status, fair/poor adherence whereas, viral load result of ≤ 1000 copies/mL had a preventive effect on attrition.Keywords: attrition, HIV/AIDS, antiretroviral therapy, retrospective cohort, EthiopiaDejen DJara DYeshanew FFentaw ZMengie Feleke TGirmaw FWagaye BDove Medical Pressarticleattritionhiv/aidsantiretroviral therapyretrospective cohortethiopia.Immunologic diseases. AllergyRC581-607ENHIV/AIDS: Research and Palliative Care, Vol Volume 13, Pp 445-454 (2021)

Attrition and Its Predictors Among Adults Receiving First-Line Antiretroviral Therapy in Woldia Town Public Health Facilities, Northeast Ethiopia: A Retrospective Cohort Study

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