Lost to Follow-Up and Its Predictors among Human Immune Deficiency Virus Infected Children on Antiretroviral Therapy, Southern Oromia, and Ethiopia: A Five Year Retrospective Cohort Study

Abstract

Background Lost to follow-up among pediatric human immune deficiency virus infected patients is a major challenge for the global scale-up of lifesaving antiretroviral therapy (ART). It is considerable obstacle for effectiveness of the program which negatively impacted on immunological benefits of ART and drug adherence. Additionally, it increases drug toxicity, resistance and acquired immune deficiency syndrome related morbidity and mortality. Therefore, it is very crucial to identify the incidence and determinants of loss to follow up among children in study area. Objectives To determine incidence and determinants of lost to follow-up among human immune deficiency virus-infected children on Anti-Retroviral Treatment. Method A retrospective cohort study was conducted among 269 randomly selected children who had been on ART in the health facilities of Shashemene Town from January 1, 2015 to December 30, 2020. Data on patients’ medical records such as patient intake form and the registers were collected using standardized checklist. Data were coded and entered by Epidata version 3.1 and analyzed by Statistical Product and Service Solutions (SPSS) version 25. The Cox proportional hazard assumption was checked using Schoenfeld residual test (global test > 0.05). Finally, adjusted hazard ratio with 95% confidence interval was computed, and variables with P-values < 0.05 in multivariable analysis were taken as significant predictors of lost to follow up. Results Of 269 HIV-infected children included in the final analysis, 43 (16%) were loss to follow up. The overall incidence rate of loss to follow up was 3.3 with (95% CI: 2.4–4.4) per 100 Child-Year of observation. Age less than 5 years (AHR:0.03 95% CI: 0.003–0.361), non-orphan status of the child (AHR = 0.13(0.048–0.340), < 30-minute distance from health facility (AHR:0.24 95% CI:0.077–0.728), disclosed HIV status (AHR :0.32 95% CI :0.126–0.795), history of opportunistic infection (AHR: 3.54, 95%CI :1.152–10.866) and CD4 below threshold (AHR:5.17 95%:CI:2.082–12.8490) were significant determinants of loss to follow up. Conclusion The incidence density of loss to follow up in this study was low as compared to other studies. The finding indicated that older children, orphan, low immune status, undisclosed HIV status and distance from health facility were independent determinants of loss to follow up. Giving special attention to older, orphan and those with low CD4 count is mandatory. Age-appropriate disclosure should also be encouraged.

Incidence of lost to follow up among HIV-positive children on antiretroviral therapy in Ethiopia: Systematic review and meta-analysis

“…In Ethiopia, there is a paucity of evidence regarding the national incidence of LTFU among HIV-positive children on ART. Moreover, previous primary studies also confirmed that the incidence of LTFU among HIV-positive children on ART varied across regions in Ethiopia [13][14][15][16][17][18][19][20][21], ranging from 3.3 per 100 child years in the Oromia region [21] to 6.3 per 100 child years in the Amhara region [15]. Conducting an aggregated study using those primary studies is important to know about the national burden of LTFU among HIV-positive children on…”

“…The rest 107 articles were assessed by reviewing the full text. Finally, twenty-four studies were eligible and incorporated in the final analysis (Fig 1) [13][14][15][16][17][18][19][20][21][27][28][29][30][31][32][33][34][35][36][37][38][39][40][41]. All studies were conducted using the cohort study design.…”

“…The hazard of LTFU was 2.1 times (HR: 2.1,95% CI:1.44; 2.95) higher among children aged between 1-5 years as compared to children aged � 5 years [15,16,20]. The likelihood of LTFU was 2.59 times (HR: 2.59, 95% CI:1.39; 4.78) higher among children who had opportunistic infection as compared to their counterparts [16,21] (Table 3).…”