title: Brief Report: Long-term Outcomes and Their Determinants in Patients on Antiretroviral Treatment in Ethiopia, 2005/6-2011/12: A Retrospective Cohort Study.
abstract: BACKGROUND
  Antiretroviral treatment (ART) programs in many resource-limited settings have expanded treatment toward universal access. Ethiopia is one of the countries that has been scaling up ART toward universal access, but with very few data on long-term outcomes and their determinants. The objective of this study was to identify the level of long-term outcomes and their determinants in patients on ART in Ethiopia.
  
  
  METHODS
  A retrospective cohort study was conducted in 3 health facilities (2 hospitals and 1 health center) between July and September, 2014. Loss to follow-up, death, attrition, and retention were the primary outcomes. Data were collected from patient registers and medical records for the period 2005/6-2011/12.
  
  
  RESULTS
  A total of 11,731 patients were included in the study. The overall retention rate was 78 per 100 person-months. Retention rates were 82%, 74%, and 72% at 24, 60, and 84 months on ART, respectively. Retention was associated with male sex, adolescent age, marital status, advanced HIV disease, illiteracy, and peer-support services; however, long-term retention was associated independently with only male sex [with adjusted hazard ratio (aHR) 0.68 (0.56 to 0.77)], married patients [with aHR 0.62 (0.54 to 0.72)], and peer-support services [with aHR 1.62 (1.58 to 1.66)].
  
  
  CONCLUSIONS
  ART programs have lost most of their patients during the first 24 months on ART. It is, therefore, imperative that HIV/ART programs ensure people are tested, linked to care, and initiated on ART early. ART programs should also design and implement interventions, including peer-support services, which are targeted to male, adolescent, unmarried, and illiterate patients.
authors.affiliation: *Ethiopian Public Health Institute, Addis Ababa, Ethiopia; †Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium; ‡Department of Epidemiology and Biostatistics, University of California, San Francisco, CA; §School of Public Health, The University of Queens Land, Brisbane, Australia; ‖Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium; ¶School of Public Health, Addis Ababa University, Addis Ababa, Ethiopia; and #Sexual Health Unit, Stonewall Medical Centre, Windsor, Australia.
authors.forename: Yibeltal
authors.initials: Y
authors.lastname: Assefa
authors.forename: Lut
authors.initials: L
authors.lastname: Lynen
authors.forename: Helmut
authors.initials: H
authors.lastname: Kloos
authors.forename: Peter
authors.initials: P
authors.lastname: Hill
authors.forename: Freya
authors.initials: F
authors.lastname: Rasschaert
authors.forename: Damen
authors.initials: D
authors.lastname: Hailemariam
authors.forename: Graham
authors.initials: G
authors.lastname: Neilsen
authors.forename: Wim
authors.initials: W
authors.lastname: Van Damme
mesh_terms: D000293:Adolescent; D000328:Adult; D044966:Anti-Retroviral Agents / Q000627:therapeutic use*; D003906:Developing Countries; D005002:Ethiopia / Q000453:epidemiology; D005260:Female; D015658:HIV Infections / Q000188:drug therapy* / Q000453:epidemiology*; D006268:Health Facilities; D006297:Health Services Accessibility; D006302:Health Services Research; D006801:Humans; D059012:Lost to Follow-Up; D008297:Male; D055118:Medication Adherence; D008875:Middle Aged; D012189:Retrospective Studies; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D044966:Anti-Retroviral Agents