Abstract:
Background: Attrition from antiretroviral therapy (ART) due to loss to follow-up or
termination can pose a risk to public health, including the emergence and transmission of drug
resistant strains of the virus. In Ethiopia, despite significant progress in expanding ART
coverage, attrition has become a major challenge in the fight against HIV.
Objective: The aim of this study was to assess incidence and predictors of attrition among adults
who received first line anti-retroviral Therapy (ART) at Wachemo University Nigist Eleni
Mohamed Memorial Comprehensive Specialized Hospital, Hosanna, Central Ethiopia, 2024.
Method: A retrospective follow-up study of 476 adults on first-line ART (Jan 1, 2019–Jan 1,
2024) was conducted using simple random sampling. Data were extracted from ART records and
analyzed in Stata 17. The proportional hazard assumption was verified (Schoenfeld residuals,
p>0.05), and multicollinearity was assessed (VIF). Median time was estimated via Kaplan–Meier
curves and log-rank tests, while predictors of attrition were identified using a Gompertz
regression model (AHRs reported). Variables with p ≤ 0.25 in bivariable analysis were included
in the multivariable model, with significance set at p<0.05.
Result: The study found 1,308.58 person-years over a median follow-up of 5 years. We found
that about 29% of patients (137 cases) dropped out of the service. The rate of attrition was 10.47
per 100 person-years. Factors associated with attrition rates were the respondents' age, location,
employment status, adherence to ART, and health status. Patients aged 25-34 years were nearly 3
times more likely to ART attrition. Unemployed individuals had the highest risk, being over 8
times more likely to drop out, followed by self-employed individuals at nearly 3 times the risk.
Patients with poor or fair adherence to ART were more than 2 times as likely to drop out.
Similarly, patients with a baseline CD4 count below 350 or those with tuberculosis at the start of
the study were at significantly higher risk of dropping out.
Conclusion: This study highlights that attrition among patients receiving ART remains a
significant public health challenge. The incidence rate observed underscores the need for
sustained efforts to retain patients in care.
Description:
A THESIS SUBMITTED TO THE SCHOOL OF PUBLIC HEALTH,
COLLEGE OF MEDICINE AND HEALTH SCIENCES, ARBA MINCH
UNIVERSITY IN PARTIAL FULFILLMENT OF THE REQUIREMENTS
FOR THE DEGREE OF MASTER OF PUBLIC HEALTH IN
EPIDEMIOLOGY AND BIOSTATISTICS
