Prepared by: Kebena Elias, MU 3^rd Cohort FETP Resident (email; kebenaeliyas40gmail.com)

Abstract

Introduction; Globally, in 2016 there were 36.7 million people living with HIV, 1.8 million new HIV infections, and 1 million AIDS related deaths. Sub-Saharan Africa (SSA) contributed 76% of the total HIV-infected people, 76% of the total new HIV infections, and 75% of the total HIV/AIDS deaths in 2015. Ending the AIDS epidemic is more than a historic obligation to the 39 million people who have died of the disease. Loss to follow up is one of the reasons for ineffectiveness of ART and it’s highly prevalent in our study area.

Objective:  To assess the incidence and determinant of loss to follow up among adult client on ART at Dubti teaching and referral hospital from 2013 to 2018.

Methods: Retrospective cohort design was conducted on adult patients who started ART at Dubti hospital, from 2013 to 2018. Loss to follow up (LTFU) is defined as not taking an ART refill for a period of 3 months or longer from the last attendance for refill and not yet classified as ‘dead’ or ‘transferred-out. Data will be collected using structured checklist after pretesting. Data will be entered into EPI-DATA version 4.2and STATA version 14 for analysis. Kaplan-Meier curve was used to estimate the time to event. Both bivariate and multivariate Cox proportional hazards models was used to identify predictors of loss to follow up and descriptive part was presented in the form of table, graphs, and number. The goodness of fit of the final model was checked by both shoenfield residual statistical test and Harrell's C concordance statistic.

Result: Total person month contributed by the study participant was 8,589. Over all the density of lost to follow up obtained was 9.7(95% CI 7.6, 12) per 100 person years. ART patient those on monthly based program were found more likely to loss from follow up than that of on ART patient on spacing (six month based) of type program (AHR: 6.69, 95% CI, 3.32, 13.4).Patient with CD4 greater than or equal to 400 were found more likely to loss from lost to follow up than those with CD4 between 50 and 200 (AHR: 1.7, 95% CI, 0.35, 8.48).

Conclusion and recommendation: The incidence of lost from follow up is 9.7per 100 person years and 17% of participant lost from program. Type of ART program, adherence level of ART patient, and CD4 level WHO stage were the factors associated with lost to follow-up. Prospective study is recommended to include additional variable

Keyword: Loss to follow up, Incidence, ART, Factors associated, Afar, Ethiopia