Retention in Care of Adult HIV Patients Initiating Antiretroviral Therapy in Tigray, Ethiopia: A Prospective Observational Cohort Study.
BACKGROUND
Although Ethiopia has been scaling up the antiretroviral therapy (ART) services, low retention in care of patients remains one of the main obstacles to treatment success. We report data on retention in care and its associated determinants in Tigray, Ethiopia.


METHODS
We used data from the CASA project, a prospective observational and multi-site study of a cohort of HIV-infected patients who initiated ART for the first time in Tigray. Four participating health facilities (HFs) located in the South of Tigray were considered for this study. Patients were followed for one year after ART initiation. The main outcome measure was represented by the current retention in care, defined as the proportion of patients who were alive and receiving ART at the same HF one year after ART initiation. Patients who started ART between January 1, 2013 and December 31, 2013 were included in this analysis. Patients were followed for one year after ART initiation. The determinants of retention were analysed using univariate and multivariate Cox Proportional Hazards model with robust sandwich estimates to account for within HF correlation.


RESULTS
The four participating HFs in Tigray were able to retain overall 85.1% of their patients after one year from starting ART. Loss to follow-up (5.5%) and transfers to other HF (6.6) were the main determinant of attrition. A multivariate analysis shows that the factors significantly associated with retention were the type of HF, gender and active TB. Alamata health center was the HF with the highest attrition rate (HR 2.99, 95% CI: 2.77-3.23). Active TB (HR 1.72, 95% CI: 1.23-2.41) and gender (HR 1.64, 95% CI: 1.10-2.56) were also significantly associated with attrition.


CONCLUSIONS
Although Ethiopia has significantly improved access to the ART program, achieving and maintaining a satisfactory long-term retention rate is a future goal. This is difficult because of different retention rates among HFs. Moreover specific interventions should be directed to people of different sex to improve retention in care in male population.
Istituto Superiore di Sanità, Rome, Italy.
Raffaella
R
Bucciardini
Istituto Superiore di Sanità, Rome, Italy.
Vincenzo
V
Fragola
College of Health Sciences, Mekelle University, Mekelle, Ethiopia.
Teshome
T
Abegaz
Istituto Superiore di Sanità, Rome, Italy.
Stefano
S
Lucattini
Tigray Regional Health Bureau, Mekelle, Ethiopia.
Atakilt
A
Halifom
College of Health Sciences, Mekelle University, Mekelle, Ethiopia.
Eskedar
E
Tadesse
College of Health Sciences, Mekelle University, Mekelle, Ethiopia.
Micheal
M
Berhe
Istituto Superiore di Sanità, Rome, Italy.
Katherina
K
Pugliese
Istituto Superiore di Sanità, Rome, Italy.
Andrea
A
Binelli
Istituto Superiore di Sanità, Rome, Italy.
Paola
P
De Castro
Istituto Superiore di Sanità, Rome, Italy.
Roberta
R
Terlizzi
Istituto Superiore di Sanità, Rome, Italy.
Luca
L
Fucili
Istituto Superiore di Sanità, Rome, Italy.
Massimiliano
M
Di Gregorio
Istituto Superiore di Sanità, Rome, Italy.
Marco
M
Mirra
Istituto Superiore di Sanità, Rome, Italy.
Erika
E
Olivieri
Tigray Regional Health Bureau, Mekelle, Ethiopia.
Tsigemariam
T
Teklu
Tigray Regional Health Bureau, Mekelle, Ethiopia.
Teame
T
Zegeye
College of Health Sciences, Mekelle University, Mekelle, Ethiopia.
Amanuel
A
Haile
Istituto Superiore di Sanità, Rome, Italy.
Stefano
S
Vella
College of Health Sciences, Mekelle University, Mekelle, Ethiopia.
Loko
L
Abraham
Hagos
H
Godefay
D000293:Adolescent; D000328:Adult; D000368:Aged; D019380:Anti-HIV Agents / Q000627:therapeutic use*; D023241:Antiretroviral Therapy, Highly Active; D018791:CD4 Lymphocyte Count; D005002:Ethiopia / Q000453:epidemiology; D005260:Female; D015658:HIV Infections / Q000188:drug therapy* / Q000453:epidemiology / Q000523:psychology / Q000821:virology; D006268:Health Facilities / Q000145:classification; D006801:Humans; D008297:Male; D008875:Middle Aged; D010349:Patient Compliance / Q000523:psychology / Q000706:statistics & numerical data*; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012737:Sex Factors; D016896:Treatment Outcome
D019380:Anti-HIV Agents