title: Discontinuation from Antiretroviral Therapy: A Continuing Challenge among Adults in HIV Care in Ethiopia: A Systematic Review and Meta-Analysis.
abstract: BACKGROUND
  Discontinuation of antiretroviral therapy (ART) reduces the immunological benefit of treatment and increases complications related to human immune-deficiency virus (HIV). However, the risk factors for ART discontinuation are poorly understood in developing countries particularly in Ethiopia. This review aimed to assess the best available evidence regarding risk factors for ART discontinuation in Ethiopia.
  
  
  METHODS
  Quantitative studies conducted in Ethiopia between 2002 and 2015 that evaluated factors associated with ART discontinuation were sought across six major databases. Only English language articles were included. This review considered studies that included the following outcome: ART treatment discontinuation, i.e. 'lost to follow up', 'defaulting' and 'stopping medication'. Meta- analysis was performed with Mantel Haenszel method using Revman-5 software. Summary statistics were expressed as pooled odds ratio with 95% confidence intervals at a p-value of <0.05.
  
  
  RESULTS
  Nine (9) studies met the criteria of the search. Five (5) were retrospective studies, 3 were case control studies, and 1 was a prospective cohort study. The total sample size in the included studies was 62,156. Being rural dweller (OR = 2.1, 95%CI: 1.5-2.7, I2 = 60%), being illiterate (OR = 1.5, 95%CI: 1.1-2.1), being not married (OR = 1.4, 95%CI: 1.1-1.8), being alcohol drinker (OR = 2.9, 95%CI: 1.9-4.4, I2 = 39%), being tobacco smoker (OR = 2.6, 95%CI: 1.6-4.3, I2 = 74%), having mental illness (OR = 2.7, 95%CI: 1.6-4.6, I2 = 0%) and being bed ridden functional status (OR = 2.3, 95%CI: 1.5-3.4, I2 = 37%) were risk factors for ART discontinuation. Whereas, having HIV positive partner (OR = 0.4, 95%CI: 0.3-0.6, I2 = 69%) and being co-infected with Tb/HIV (OR = 0.6, 95%CI: 0.4-0.9, I2 = 0%) were protective factors.
  
  
  CONCLUSIONS
  Demographic, behavioral and clinical factors influenced ART treatment discontinuation. Hence, we recommend strengthening decentralization of HIV care services in remote areas, strengthening of ART task shifting, application of seek-test-treat-succeed model, and integration of smoking cession strategies and mental health care into the routine HIV care program.
authors.affiliation: Public Health, Flinders University, Adelaide, Australia.|Epidemiology, Jimma University, Jimma, Ethiopia.
authors.forename: Hailay Abrha
authors.initials: HA
authors.lastname: Gesesew
authors.affiliation: Public Health, Flinders University, Adelaide, Australia.
authors.forename: Paul
authors.identifier: http://orcid.org/0000-0002-5559-9714
authors.initials: P
authors.lastname: Ward
authors.affiliation: Epidemiology, Jimma University, Jimma, Ethiopia.
authors.forename: Kifle Woldemichael
authors.initials: KW
authors.lastname: Hajito
authors.affiliation: Joanna Briggs Institute, Adelaide University, Adelaide, Australia.|Department of Health Education and Behavioral Sciences, Jimma, Ethiopia.
authors.forename: Garumma Tolu
authors.initials: GT
authors.lastname: Feyissa
authors.affiliation: Gus Fraenkel Medical Library, Flinders University, Adelaide, Australia.
authors.forename: Leila
authors.identifier: http://orcid.org/0000-0003-1667-829X
authors.initials: L
authors.lastname: Mohammadi
authors.affiliation: Public Health, Flinders University, Adelaide, Australia.
authors.forename: Lillian
authors.initials: L
authors.lastname: Mwanri
mesh_terms: D000328:Adult; D019380:Anti-HIV Agents / Q000008:administration & dosage* / Q000627:therapeutic use; D005002:Ethiopia; D005260:Female; D015658:HIV Infections / Q000188:drug therapy*; D006801:Humans; D008297:Male; D012307:Risk Factors
chemical_list: D019380:Anti-HIV Agents