Background: Despite ART increased survival time and improved quality of life among HIV-infected children, loss to follow-up is a serious concern and negatively affecting the treatment outcomes of HIV-infected children. To tackle this problem, recent information concerning loss to follow-up among HIV-infected children on ART is vital. Therefore, this study was conducted to assess the incidence and predictors of loss to follow-up among HIV-infected children receiving ART at Debre Markos Referral Hospital.

Methods: An institution-based retrospective follow-up study was conducted among 408 HIV-infected children on ART at Debre Markos Referral Hospital from 2006 to March 15, 2019. The data abstraction tool was adapted from ART entry and follow-up forms. Data were entered using Epi-Data Version 4.2 and analyzed using Stata Version 14.1 stat. The Kaplan-Meier survival curve was used to estimate the survival time and Log rank test was used to compare the survival curves of categorical variables. Both bi-variable and multivariable Cox proportional hazards regression models were used to identify the predictors of loss to follow-up.

Results: In this study, the overall incidence rate of lost to follow-up was found to be 4.5 (95%CI: 3.5, 5.7) per 100-child years of observation. Children living in rural areas (AHR: 3.2, 95%CI: 2.0, 5.3), having fair/poor ART drug adherence (AHR: 2.3, 95%CI: 1.4, 3.7), children started ART through test and treat approach (AHR: 2.7, 95%CI: 1.4-5.5), and children started protease inhibiter based ART drugs (AHR: 2.2, 95%CI: 1.1, 4.4) were at higher risk of loss to follow-up.

Conclusion: In the study, relatively low incidence of loss to follow-up was observed. Children living in rural areas, having fair/poor ART drug adherence, started ART through test and treat approach, and started protease inhibitor-based ART drugs were at higher risk of loss to follow-up.

Keywords:  ART, Children, Debre Markos, HIV, LTFU