Abstract

Background: In Ethiopia the scale up of free antiretroviral therapy (ART) services has been one of the greatest achievements of the Human Immunodeficiency Virus (HIV) programme response over the last decade. However, retention (1-attrition) is the major challenge of the ART program. Retention in care is necessary to optimize clinical outcomes in people living with HIV. More recently, it has highlighted as an important element of clinical success for the patient and the program. In Ethiopia, little is known about the long-term attrition and its pridictors. Therefore, this study assesses the incidence and of pridictors of attrition rate.

Methods: Retrospective cohort studies were used among adults (age ≥ 15 years) on ART. Records of adults who start treatment between June 2010 and May 2015 were retrieved.  The Kaplan–Meier method used to estimate the probability of retention at different time points. The Cox proportional hazards model was used to identify factors associated with attrition.

Result: A total of 1026 HIV patients were enrolled in the ART program between June 2010 and May 2015. At the end of the 60 months of the program initiation, 77% of the patients retained on treatment, 4.8% died, and 18.2% were lost to followup. Low body mass index (adjusted hazard ratio (AHR) was 2.93; 95% CI: 1.45–5.9); WHO stage IV (AHR 1.9; 95% CI: 1.4–3.4)) and ambulatory functional status (AHR = 1.63; 95% CI: (1.05, 2.55) were pridictors of attrition.

Conclusion: the five-year attrition rates among patients living with HIV and enrolled into care were still higher, and substantial magnitude of lost to follow up was observed.Malnutrition, ambulatory functional status, and advanced WHO stage were significantly increasing the rate of attrition from treatment. Early HIV testing could help to avoid advancced WHO stage at treatment iniciation. Moreover, provide and strengthning comprehensive nutritional support could be implementing to increase body mass index to normal levels which inturn improve retention in HIV care and treatment.