HIV patients retention and attrition in care and their determinants in Ethiopia: a systematic review and meta-analysis

Moges, Nurilign Abebe; Adesina, Olubukola Adeponle; Micheal, Okunlola; Berhane, Yemane

doi:10.1186/s12879-020-05168-3

Cited by 31 publications

(30 citation statements)

References 81 publications

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“…For the past 34 years, TASO, using its experienced and dedicated health workers, counsellors and peer educators has been closely monitoring, and providing intensive counselling and continuous education to PLHIV under TASO care, a unique support different from elsewhere. This could explain the higher retention reported in this paper compared to other studies conducted in Ethiopia [ 22 ], Mozambique [ 23 ], and Cameroon [ 24 ]. However, the retention rates reported in our study are lower than those reported in the SEARCH study conducted in Kenya and Uganda [ 20 ] and this could be attributed to the large number of patients enrolled in HIV care each month visa-vie the available resources.…”

Section: Discussioncontrasting

confidence: 62%

“…Overall, our study shows higher rates of retention for PLHIV compared to other studies conducted elsewhere [ 22 – 24 ]. For the past 34 years, TASO, using its experienced and dedicated health workers, counsellors and peer educators has been closely monitoring, and providing intensive counselling and continuous education to PLHIV under TASO care, a unique support different from elsewhere.…”

Section: Discussioncontrasting

confidence: 53%

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Effect of universal test and treat on retention and mortality among people living with HIV-infection in Uganda: An interrupted time series analysis

et al. 2022

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Background Few studies have analysed the effect of HIV universal test and treat (UTT) on retention and mortality among people living with HIV (PLHIV) in routine care. We examined six-month retention and mortality at 11 health facilities (HFs) run by a large NGO, The AIDS Support Organisation (TASO), before and after UTT. Methods We used a quasi-experimental study using patient data extracted from 11 TASO HFs. Two periods, one before UTT (2015–2016) and the other during UTT (2017–2018) were compared. The primary outcome was six-month retention defined as the proportion of PLHIV who were alive and in care at six months from enrolment. The secondary outcome was six-month mortality defined as the proportion of PLHIV who died within six months from enrolment. We performed an interrupted time series analysis using graphical aids to study trends in six-month retention and mortality and a segmented regression to evaluate the effect of UTT. We used a generalized linear mixed model (GLMM) and generalized estimating equations (GEE) to account for facility-level clustering. Results Of the 20,171 PLHIV registered between 2015 and 2018 and included in the analysis, 12,757 (63.2%) were enrolled during the UTT period. 5256/7414 (70.9%) of the pre-UTT period compared to 12239/12757 (95.9%) of the UTT were initiated on ART treatment with 6 months from enrolment. The median time from enrolment to initiating ART was 14 (interquartile range (IQR): 0–31) days for the pre-UTT compared to 0 (IQR: 0–0) days for the UTT period. The median age at enrolment was 32.5 years for the pre-UTT and 35.0 years for the UTT period. Overall, the six-month retention just after scale-up of UTT, increased by 9.2 percentage points (p = 0.002) from the baseline value of 82.6% (95% CI: 77.6%-87.5%) but it eventually decreased at a rate 1.0 percentage point (p = 0.014) for cohorts recruited each month after UTT. The baseline six-month mortality was 3.3% (95% CI: 2.4%-4.2%) and this decreased by 1.6 percentage points (p = 0.003) immediately after UTT. The six-month mortality continued decreasing at a rate of 0.1 percentage points (p = 0.002) for cohorts enrolled each month after UTT. Retention differed between some health facilities with Rukungiri HF having the highest and Soroti the lowest retention. Retention was slightly higher among males and younger people. Mortality was highest among people aged 50 years and more. The effect of UTT on retention and mortality was similar across sex and age groups. Conclusion Overall, UTT significantly led to an immediate increase in retention and decrease in mortality among PLHIV enrolled in HIV care from 11 HFs run by TASO in Uganda. However, retention (and mortality) significantly decreased for cohorts enrolled each month after UTT. Retention was highest in Rukungiri and lowest in Soroti HFs and slightly higher in males and younger people. Mortality was highest in older patients and lowest in adolescents. We recommend for innovative interventions to improve the overall retention particularly in facilities reporting low retention in order to achieve the UNAIDS 2030 target of 95-95-95.

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Section: Discussioncontrasting

confidence: 62%

Section: Discussioncontrasting

confidence: 53%

Effect of universal test and treat on retention and mortality among people living with HIV-infection in Uganda: An interrupted time series analysis

et al. 2022

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“…These numbers are similar to those of the monoinfected group in this study but significantly lower than those found in the coinfected group. A systematic review in Ethiopia showed an overall attrition of 21% in HIV-positive people enrolled for ART care, which is also comparable with the monoinfected cumulative attrition in this study even after excluding those transferred out from our analysis; the other study considered transferred-out patients to be retained on ART [ 24 ]. Therefore, direct comparison with this study may not be reasonable.…”

Section: Discussionsupporting

confidence: 79%

Retention on antiretroviral therapy in person with HIV and viral hepatitis coinfection in Ethiopia: a retrospective cohort study

et al. 2022

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Background HIV coinfection with viral hepatitis B (HBV) or viral hepatitis C (HCV) is not uncommon in Ethiopia. Although the coinfections are presumed to interfere with antiretroviral treatment (ART), this is not widely studied in Sub-Saharan African settings. This study was conducted to determine ART retention in persons coinfected with HIV + HBV or HIV + HCV. Methods We reviewed the medical records of HIV-positive adults who initiated ART between 2011 to 2018 in four high-burden hospitals of Addis Ababa. Retention in care was the primary outcome of the study, which was compared between HIV and either HBV or HCV coinfected persons, and HIV-monoinfected persons. A parametric Gompertz regression model was used to compare retention between the coinfected and monoinfected groups. Results A total of 132 coinfected persons and 514 HIV-monoinfected individuals who initiated ART in 2011–2018 were compared. At 12-months of follow-up, 81.06% [95% CI: 73.3–86.9%] of the coinfected and 86.96% [95% CI: 83.7–89.6%] of the monoinfected were still on ART care. Cumulative retention in the coinfected group was 68.93% [60.4–76.3%] versus 80.35% [76.6–83.5%, p = 0.0048] in the monoinfected group. The cumulative retention was lower (61.25, 95% CI: 49.9–71.4%) in male coinfected patients than male monoinfected patients (77.77, 95% CI: 71.8–82.7%, p = 0.0041). In contrast, cumulative retention was similar in females in the coinfected group (80.76, 95% CI:67.3–89.5%) versus the monoinfected group (82.29, 95% CI:77.4–86.3%, p = 0.792). Overall, HIV-positive with viral hepatitis coinfection were 24 and 31% less likely to still be on ART care than the monoinfected group at 12 months and overall, with sub-distribution adjusted hazard ratio (AHR) of 0.76(95% CI:0.61–0.96, p = 0.021) and 0.69(95% CI:0.54–0.87, p = 0.002) respectively. Conclusions We observed that coinfected individuals are less likely to stay on ART than HIV monoinfected individuals. The low retention in the coinfected group from this study may affect the success of survival gained in people living with HIV (PLHIV) in the long term. More concerted efforts need to be made to retain coinfected individuals at least at the level of monoinfected persons on long-term ART care. Future studies are needed to better understand the difference in retention, preferable in a prospective manner.

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“…Major risk factors to LTFU from ART programmes include several sociodemographic (male sex, older age, being single, unemployment, lower educational status), clinical (advanced WHO stage, low weight, worse functional status), patient behaviour (poor adherence, nondisclosure), treatment related and system level factors [ 7 ]. A systemic review of a pooled magnitude of HIV patient clinical retention and attrition in Ethiopia found out that major determinants of attrition were being unmarried patient, non-disclosed HIV status, poor drug adherence, poor functional status, being underweight and advanced clinical stage [ 8 ]. Knowledge of risk factors should be used to better develop retention interventions in HIV programmes.…”

Section: Introductionmentioning

confidence: 99%

Interventions to improve early retention of patients in antiretroviral therapy programmes in sub-Saharan Africa: A systematic review

et al. 2022

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Background Several interventions to improve long term retention (12 months and above) on treatment have been rigorously evaluated in Sub-Saharan Africa (SSA). However, research on interventions to improve retention of patients in the early stages of treatment (6 months) during this era of Universal Test and Treat has only recently emerged. The aim of this study is to systematically map evidence of interventions used to improve early retention of patients in antiretroviral therapy (ART) programmes in SSA. Methods We searched PubMed, EMBASE and Cochrane electronic databases to identify studies describing interventions aimed at improving early retention in ART treatment. We applied the methodological frameworks by Arksey and O’Malley (2005) and Levac et al. (2010). We also followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) checklist. Interventions were categorized according to key broad areas in the existing literature. Results A total of 2,241 articles were identified of which 19 met the inclusion criteria and were eligible for this review, with the majority either being randomized control trials 32% (n = 6) or cohort studies 32% (n = 6). The studies reviewed were conducted in 11 SSA countries. The most common interventions described under key broad areas included: Health system interventions such as Universal Test-and-Treat, integration of ART initiation, HIV Testing and Counselling and Antenatal Care services and reduction of ART drug costs; Patient centered approaches such as fast track ART initiation, Differentiated Drug Delivery models and point of care HIV birth testing; Behavioral interventions and support through lay counselors, mentor mothers, nurse counselors and application of quality improvement interventions and financial incentives. Majority of the studies targeted the HIV positive adults and pregnant women. Conclusion With the introduction of Universal Test-and-Treat and same-day initiation of ART, findings suggest that adoption of policies that expand ART uptake with the goal of reducing HIV transmission at the population level, promoting patient centered approaches such as fast track ART initiation, Differentiated Service Delivery models and providing adequate support through Mentor Mothers, lay and nurse counselors may improve early retention in HIV care in SSA. However, these interventions have only been tested in few countries in the region which points to how hard evidence based HIV programming is. Further research investigating the impact of individual and a combination of interventions to improve early retention in HIV care, including for various groups at high risk of attrition, is warranted across SSA countries to fast track the achievement of 95-95-95 Joint United Nations Programme on HIV/AIDS (UNAIDS) targets by 2030.

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HIV patients retention and attrition in care and their determinants in Ethiopia: a systematic review and meta-analysis

Cited by 31 publications

References 81 publications

Effect of universal test and treat on retention and mortality among people living with HIV-infection in Uganda: An interrupted time series analysis

Effect of universal test and treat on retention and mortality among people living with HIV-infection in Uganda: An interrupted time series analysis

Retention on antiretroviral therapy in person with HIV and viral hepatitis coinfection in Ethiopia: a retrospective cohort study

Interventions to improve early retention of patients in antiretroviral therapy programmes in sub-Saharan Africa: A systematic review

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