Attrition and Its Predictors Among Adults Receiving First-Line Antiretroviral Therapy in Woldia Town Public Health Facilities, Northeast Ethiopia: A Retrospective Cohort Study

Introduction: There is an expansion and advancement of antiretroviral therapy. However, attrition of patients from HIV care is one of the major drivers of poor performance of HIV/AIDS programs, which leads to drug resistance, morbidity and mortality. The study aimed to assess the incidence of attrition and its predictors among adults receiving first-line antiretroviral therapy.

Methods: An institution-based retrospective cohort study was conducted among 634 adults receiving antiretroviral therapy, and study participants were selected using a simple random sampling technique. Data were cleaned and entered into Epi Data version 3.1 and exported to STATA 14.1 for further analysis. The predictors of attrition were identified using bivariable and multivariable Cox Proportional hazard models; then, variables at a p-value of less than 0.25 and 0.05 were included in the multivariable analysis and statistically significant, respectively.

Results: The total time observed was found to be 1807.08 person-years of observation with a median follow-up time of 2.67 years (IQR 1.25-4.67). The incidence rate of attrition was 8.36 (95% CI: 7.12-9.80) per 100 person-years. Significant predictors of attrition were being young age [adjusted hazard ratio (AHR) =2.0, 95% CI, (1.11-3.58)], nearest calendar year of ART initiation [AHR =2.32, 95% CI, (1.08-5.01)], bedridden functional status [AHR=3.25, 95% CI, (1.33-7.96)], WHO stage III [AHR=3.57, 95% CI, (1.58-8.06)] and stage IV [AHR=5.46, 95% CI, (1.97-15.13)], viral load result of ≤1000 [AHR=0.11, 95% CI, (0.06-0.23)], disclosure status [AHR=2.03, 95% CI, (1.22-3.37)] and adherence level of poor [AHR=3.19, 95 CI, (1.67-6.09)].

Conclusion: The result of this study showed that the incidence of attrition among adults receiving antiretroviral therapy was high. However, as a standard, every client who started antiretroviral therapy should be retained. Positive predictors of attrition were young age (15-24), recent year of ART initiation, baseline functional status, advanced WHO stage III and IV, no disclosure status, fair/poor adherence whereas, viral load result of ≤1000 copies/mL had a preventive effect on attrition.