Predictors of Loss to Follow-Up among HIV-Infected Adults after Initiation of the First-Line Antiretroviral Therapy at Arba Minch General Hospital, Southern Ethiopia: A 5-Year Retrospective Cohort Study

Tracking People Living with HIV in Loss to Follow Up in Central Brazil: A Call for Attention to Health Services

Despite the effectiveness of antiretroviral therapy (ART), human immunodeficiency virus (HIV) infection remains a global public health concern. However, weaknesses in its management regarding access to integrated HIV care include treatment gaps and loss to follow-up (LTFU) from antiretroviral treatment (ART). This study aimed to characterize the epidemiological and clinical profiles of people living with HIV/AIDS (PLHA) in LTFU from HIV care in Campo Grande, Central Brazil. This retrospective cross-sectional study was conducted between January 2021 and April 2022 using secondary data from PLHA who had LTFU in Campo Grande. A total of 852 patients with PLHA were included in this study. The majority of participants in LTFU were male (63.1%), had a CD4 cell count > 200 cells/mm3 (68.2%), and had been treated for ≥ 3 months (86.4%). Only 287 (33.7%) participants had undetectable HIV viral load. Of the total number of patients who returned to treatment during the study period, 448 (54.3%) were LTFU-positive. The tracking strategy was not applied to 556 (65.26%) patients, and 44.4% of the participants had been in spontaneous demand. These results highlight the relevance of patient-centered interventions and the need to ensure early treatment and promote retention in care systems with consequent viral suppression, impacting the healthcare indicators of the population, with emphasis on health managers and stakeholders in HIV care.

Factors influencing patients on antiretroviral therapy loss to follow up: A qualitative analysis of healthcare workers perspective

Despite expanded and successful antiretroviral therapy program coverage, a large proportion of people drop out at different stages along their treatment course. As a result, treatment gains do not reach a large proportion of these groups. It has been demonstrated that around half of the patients who test Human immunodeficiency virus (HIV) positive in Sub-Saharan Africa are lost between testing and being considered for eligibility for therapy. The purpose of this study was to determine the factors that influence patients on antiretroviral therapy who lost to follow up in HIV treatment clinics in Asunafo South District, Ahafo Region. We used phenomenological qualitative research approach in conducting this study. Purposive sampling was used to select respondents, while key informant interview was used to collect the data. The major identified challenges in carrying out follow-up visits of patients on antiretroviral therapy were wrong addresses and phone numbers of clients, coupled with poor telecommunication networks, geographical relocation of clients, poor documentation of patients' information, and non-availability of means of transport. The preferred reengagement strategies identified in this study were: supply of drugs through home visits, intensive education, engaging the services of community-based surveillance officers, enhanced regular phone calls visits, adoption and use of an integrated antiretroviral therapy clinic, intensified education on HIV, and involvement of religious leaders. In conclusion, all clinicians and stakeholders should consider the identified challenges and reengagement strategies when providing antiretroviral services.

Incidence of lost to follow up among HIV-positive children on antiretroviral therapy in Ethiopia: Systematic review and meta-analysis

BACKGROUND

At the end of 2022, globally, only 46% of children (aged 0-14 years) on ART had suppressed viral loads. Viral load suppression is crucial to reduce HIV-related deaths. To suppress the viral load at the expected level, children must be retained in ART treatment. Nevertheless, lost to follow-up from ART treatment continues to be a global challenge, particularly, in developing countries. Previously, primary studies were conducted in Ethiopia to assess the incidence of lost to follow-up among HIV-positive children on ART treatment. However, variations have been seen among the studies. Therefore, this systematic review and meta-analysis aimed to estimate the pooled incidence of lost to follow-up among HIV-positive children on ART and identify its associated factors in Ethiopia.

METHODS

We searched PubMed, HINARI, Science Direct, Google Scholar, and African Journals Online to obtain articles published up to November 20, 2023. Critical appraisal was done using the Joanna Briggs Institute checklist. Heterogeneity was identified using I-square statistics. Funnel plot and Egger's tests were used to identify publication bias. Data was presented using forest plots and tables. Random and fixed-effect models were used to compute the pooled estimate.

RESULTS

Twenty-four studies were included in the final analysis. The pooled incidence of lost to follow-up among HIV-positive children on ART was 2.79 (95% CI: 1.99, 3.91) per 100-child-year observations. Advanced HIV disease (HR: 2.20, 95% CI: 1.71, 2.73), having opportunistic infection (HR: 2.59, 95% CI: 1.39; 4.78), fair or poor ART treatment adherence (HR: 2.92, 95% CI: 1.31; 6.54) and children aged between 1-5 years (HR: 2.1,95% CI: 1.44; 2.95) were factors associated with lost to follow up among HIV positive children on ART.

CONCLUSIONS

The overall pooled incidence of lost to follow-up among HIV-positive children on ART is low in Ethiopia. Therefore, counseling on ART drug adherence should be strengthened. Moreover, emphasis has to be given to children with advanced HIV stage and opportunistic infection to reduce the rate of lost to follow up among HIV-positive children on ART.

TRIAL REGISTRATION

Registered in PROSPERO with ID: CRD42024501071.

Incidence and predictors of loss to follow-up among adult patients receiving antiretroviral therapy in Central Ethiopia: a multi-center retrospective cohort study

Background

Globally, loss to follow-up (LTFU) remains a significant public health concern despite the rapid expansion of antiretroviral medication programs. It is a significant cause of treatment failure and threatens the enhancement of HIV treatment outcomes among patients on antiretroviral therapy (ART). However, there is a paucity of evidence on its incidence and predictors in Ethiopia. Thus, this study aimed to examine the incidence and predictors of LTFU among adult HIV patients receiving ART at hospitals in Central Ethiopia.

Methods

A multi-centered facility-based retrospective cohort study was conducted among 432 randomly selected adult patients who received antiretroviral therapy. Data were entered into EpiData version 3.1 and exported to Stata version 14 for analysis. The Kaplan-Meier failure function was employed to determine the overall failure estimates, and the log-rank test was used to compare the probability of failure among the different categories of variables. The Cox proportional hazard model was used to identify independent predictors of LTFU.

Results

Overall, 172 (39.8%) study participants were lost to follow-up over the 10-year follow-up period with an incidence rate of 8.12 (95% CI: 7.11, 9.09) per 1,000 person-months. Undisclosed HIV status (AHR: 1.96, 95% CI: 1.14, 3.36), not able to work (AHR: 1.84, 95% CI: 1.13, 2.22), opportunistic infections (AHR: 3.13, 95% CI: 2.17, 4.52), CD4 < 200 cell/mL (AHR: 1.95, 95% CI: 1.18, 3.21), not receiving isoniazid preventive therapy (IPT) (AHR: 2.57, 95% CI: 1.62, 4.06), not participating in clubs (AHR: 1.68, 95% CI: 1.10, 2.22), side effects of drugs (AHR: 1.44, 95% CI: 1.02, 2.04), and high viral load (AHR: 3.15, 95% CI: 1.81, 5.47) were identified as significant predictors of loss to follow-up.

Conclusion

In this study, the incidence of LTFU was high. The focus should be on creating awareness and prevention programs that aim to reduce loss to follow-up by continuing counseling, especially on the negative effects of loss to follow-up and the benefits of ART care.

Determinants of Loss to Follow Up Among Adult People Living with HIV Enrolled in Antiretroviral Therapy in West Wollega Public Hospitals, Oromia, Ethiopia

Background

Antiretroviral Treatment (ART) reduces morbidity and mortality in patients with human immunodeficiency virus (HIV). However, clients loss to follow-up (LTFU) from the treatment poses a paramount problem to the public, healthcare, and patient outcome. Thus, this study identified determinants of loss to follow-up to ART among adult clients in West Wollega hospitals, Oromia, Ethiopia, in 2021.

Methods

An unmatched case-control study was conducted and a systematic random sampling technique was used. Data were collected from patient charts by three BSC nurses and three card reporters using a structured checklist. Then, it was entered into Epi-data version 3.1 and analyzed using SPSS version 21. Descriptive statistics (frequency and percentage) were used to present the results. Bivariate and multivariable logistic regression analyses were performed using the backward stepwise method. Adjusted odds ratio (AOR) and p-values <0.05 were used to declare significant association with loss to follow-up. Model fitness was checked using Hosmer-Lemeshow goodness-of-fit.

Results

A total of 399 (133 patients and 266 controls) participated in this study. Rural residents (AOR:3.46, 95% CI:1.65, 7.25), male patient (AOR: 2.65 95% CI 1.54,4.55), lack of formal education (AOR: 4.35, 95% CI 1.53, 12.41), base line CD4 ≤350 (AOR: 5.25, 95% CI 1.93,14.24), poor functional status (AOR: 4.298, 95% CI 5.33,34.62) and WHO stages III & IV (AOR: 2.65, 95% CI 1.68,4.19), and tuberculosis co-infection (AOR: 2.82, 95% CI 1.11,7.45) were determinant factors of loss to follow up.

Conclusion

Rural residence, male sex, daily laborer, no formal education, baseline CD4 count <350 cells/mm3, baseline advanced WHO clinical stage, and TB co-infection were determinants of LTFU. Therefore, emphasis should be given to the identified factors along with awareness creation and health education sessions. Regular TB screening, optimal adherence regardless of their stay on ART, and follow-up study are recommended.

Incidence and predictors of loss to follow-up among Ethiopian children on antiretroviral therapy: a systematic review and meta-analysis

INTRODUCTION

Loss of follow-up (LTFU) from ART regular follow-up is one of the key acknowledged causes for the development of ART-resistant virus strains currently. It becomes a major weakness for the successful implementation of HIV care and treatment programs mainly in Sub-Saharan Africa but also globally. About 20-40% of children on ART loss their regular ART follow-up annually. Because of the inconsistency of the prior publications' findings, policymakers, programmers, and healthcare providers find it difficult to intervene. Hence, this study was conducted to provide a pooled incidence and identify the predictors of LTFU among children on ART in Ethiopia.

METHODS

Articles were searched from PubMed/ MEDLINE, CINAHL, EMBASE, Google Scholar, and Science Direct, as well as organizational records and websites. This review included both retrospective and prospective follow-up studies published in English. The data were extracted using Microsoft Excel and exported into Stata™ Version 17.0 for further processing and analysis. The presence of heterogeneity was assessed using forest plots with the I2 test. To identify the source of heterogeneity subgroup analysis, meta-regression, publication bias, and sensitivity analysis were computed. The pooled incidence of LTFU was estimated using a random effects meta-analysis model with the DerSimonian-laired method. To identify the predictors, a 95% confidence interval with relative risk was used to declare the presence or absence of an association.

RESULTS

In this systematic review and Meta-analysis, nine studies with a total of 3336 children were included. The pooled incidence of LTFU from ART was 5.83 (95% CI: 3.94, 7.72) per 100 children-years of observation with I2: 83% & p-value < 0.001. Those children who were from rural were had a 1.65 (95% CI: 1.06, 2.52) times higher chance of getting LTFU when compared with their counterparts. Children who had poor ART adherence had a 2.03 (95% CI: 1.23, 3.34) times higher chance of experiencing LTFU of ART than children having good ART adherence.

CONCLUSIONS

Among Ethiopian children on ART, one out of 167 had the risk of experiencing LTFU. Being rural dwellers and having poor ART adherence were the identified predictors of LTFU. Close follow-up and phone message text should be used to have good ART adherence among rural dwellers to meet the predetermined goal of ART.

Association between psychological discomforts and sleep quality among people living with HIV/AIDS

BACKGROUND

Psychological discomfort and sleep problems are considered separate disorders. Due to the high prevalence of both disorders among people living with HIV (PLWH), this study was designed to evaluate how those challenges are present among PLWH.

METHOD

A cross-sectional study was conducted using data from a national survey of 1185 confirmed PLWH from 15 provinces in Iran from April to August 2019. Psychological discomfort and sleep quality were assessed using standardized versions of related Persian questionnaires. Logistic regression was used to assess the association between psychological discomfort and sleep quality in PLWH.

RESULTS

The overall prevalence of poor sleep quality, depression, anxiety, and stress was 47.71%, 50.95%, 44.26%, and 41.77%, respectively. The results of multivariate-adjusted logistic regression showed that each psychological discomfort covariate increased the odds of poor sleep quality. Depression by adjusting for anxiety and stress, anxiety by adjusting for depression and stress, and stress by adjusting for depression and anxiety all increased the odds of poor sleep quality.

CONCLUSION

A high prevalence of psychological discomfort was observed in PLWH. Depression, anxiety, and stress were strongly associated with sleep quality. PLWH needed more attention and social support in order to reduce sleep and psychological issues.

Loss to Follow-up and Death Among Individuals With Newly Diagnosed Human Immunodeficiency Virus Receiving Dolutegravir-Based First-Line Antiretroviral Treatment in Eastern Ethiopia: Implications for 95% United Nations Targets

Background

Loss to follow-up (LTFU) and death are unfavorable outcomes of human immunodeficiency virus (HIV) treatment. This study aimed to identify the predictors of LTFU and death among individuals with newly diagnosed HIV receiving dolutegravir (DTG)-based first-line antiretroviral treatment (ART) in eastern Ethiopia.

Methods

A multisite prospective cohort study was carried out between October 2020 and July 2022. New case patients who started ART were enrolled consecutively and then followed up for the next 6 months. A structured questionnaire and checklists were used to collect data. HIV viral load was determined using the Abbott RealTime HIV-1 assay. Bivariable and multivariable logistic regression models were used to identify baseline factors associated with the outcomes.

Results

A total of 235 people with newly diagnosed HIV were enrolled; 16.6% (95% confidence interval, 12.3%-21.9%) were lost to follow-up, and 5.9% (3.5%-9.8%) died within 6 months of follow-up. Baseline World Health Organization clinical stage I (adjusted odds ratio, 3.93 [95% confidence interval, 1.34-11.57]), low viral load (3.67 [1.09-12.36]), and body weight (1.04 [1.01-1.07]) were predictors of LTFU, whereas nonfunctional status (10.02 [1.9-51.3]) was the only factor associated with death.

Conclusions

LTFU and death rates among patients with DTG were relatively high, accounting for roughly a quarter of the attrition of people with newly diagnosed HIV from ART care and services. Thus, targeted interventions are required to reduce LTFU and death among individuals with HIV on ART. Further investigation is necessary to evaluate the long-term effects of DTG-based regimens on LTFU and its impact on HIV mortality rates, and qualitative research, specifically tracing LTFU, is recommended.

Incidence and Predictors of Loss to Follow-Up Among Adults on Antiretroviral Therapy in South Gondar Governmental Hospitals, Ethiopia: Retrospective Cohort Study

Background

Approximately 38.4 million adult people worldwide live with HIV, of which the majority live in Africa. In Ethiopia increasing the quality of life to HIV patients and preventing HIV transmission are challenging. Even though test-and-treat strategy is applied for early enrollment to ART, poor retention and loss to follow-up are hindering the care.

Objective

This study examined the incidence and predictors of loss to follow-up among adult HIV patients on ART in South Gondar governmental hospitals, September 11, 2017-September 10, 2022.

Methods

A multi-facility-based retrospective follow-up study was conducted. Study subjects were assigned using simple random sampling methods by their medical record numbers. The data were entered into EPI data version 3.0.2 and exported to STATA version 17 for analysis. The Kaplan-Meier failure function was employed to determine the overall failure estimates. Cox proportional hazard model was tailored for both bi-variable and multivariable. Variables at p-value <0.05 with 95% CI were significantly associated with loss to follow-up.

Results

In this study, about 559 adult HIV survivors were included, and the response rate was 98%. The mean age and standard deviation (±SD) of study subjects were 36.6±9.3 years. The incidence rate of loss to follow-up was 6.7 per 100 person-years (95% CI: 5.6, 8.1). Educational status [AHR: 1.68 (95% CI: 1.04, 2.72)], substance use [AHR: 2.38 (95% CI: 1.50, 3.75)], and ART adherence [AHR: 3.33 (95% CI: 1.38, 8.08)] were significant determinants to loss to follow-up.

Conclusion

In conclusion, the study finding reported that the incidence of loss to follow-up was low. HIV patients who did not have formal education, substance users, and poor ART adherence were at greater hazard of being lost to follow-up. In order to mitigate the rate of loss to follow-up, it is recommended to strengthen the available intervention modalities.

'I am struggling to survive' - limited living conditions increase the burden of HIV: A qualitative study

The human immunodeficiency virus (HIV) continues to have life-limiting health consequences for many individuals and remains a significant threat to global public health. This qualitative study explores the experiences of people living with HIV in Sidama, Ethiopia. Interviews with 19 adults recruited from an HIV outpatient clinic were conducted using a semi-structured interview guide. The analysis method used was systematic text condensation. The results reveal that an HIV diagnosis triggered strong emotions. Economic concerns, stigma, and discrimination also increased the burden of a diagnosis, which could lead to a loss of income or housing. Consequently, informants' ability to maintain a regular life and receive social and psychological support was reduced. Religious faith provided strength to informants, though they stated that some religious leaders do not support antiretroviral therapy. Understanding the everyday challenges of people living with HIV is crucial for health professionals and health programme developers working to promote health and enable people to follow their recommended course of treatment. Person-centred care is recommended. In particular, the poorest should receive attention. It is also crucial to reduce stigma and discriminatory attitudes towards people living with HIV and to motivate faith leaders to prevent HIV stigma and support antiretroviral therapy.